Implementation Barriers in the Management of Maternal Syphilis by Midwives at Two Primary Healthcare Clinics in the Free State Province, South Africa

This study aimed to identify barriers to managing pregnant women and their newborns exposed to or infected with syphilis and propose solutions based on existing treatment guidelines. Conducted at two primary healthcare clinics in the Free State province, the study used a quantitative design and purposive sampling to survey healthcare professionals involved in antenatal, childbirth and perinatal services across two health districts. A questionnaire captured the knowledge, views and practices of 14 midwives, two operational managers and one district clinical manager regarding maternal and congenital syphilis. All midwives were knowledgeable and experienced, with access to various treatment guidelines, though most relied on the 2016 Guidelines for Maternity Care in South Africa. Barriers identified included inconsistent adherence to guidelines, irregular screening for syphilis and HIV, and a lack of serological testing in 64% of babies born to mothers with syphilis. Further challenges included inadequate training on new guidelines, lack of partner contact tracing, resource shortages and staffing inconsistencies. Despite their knowledge, midwives face implementation challenges that hinder effective practice. Regular training is recommended to support midwives and nurses in managing sexually transmitted diseases.