Characteristics of Congenital Syphilis at the Neonatal Center of Excellence Unit, University Teaching Hospital -Children's Division, Lusaka, Zambia-Retrospective Pilot Study.

Background
The global incidence of congenital syphilis is increasing, particularly in developing countries, resulting in significant fetal and neonatal morbidity and mortality. Understanding the determinants contributing to this rise is essential for formulating effective preventive interventions.
Subject and methods
This pilot study examines retrospective cross-sectional data from a 12-month period, sourced from the ward register at the Neonatal Centre of Excellence, University Teaching Hospital–Children's Division in Lusaka, Zambia. The prevalence and characteristics of congenital syphilis in 758 hospitalized neonates were studied using percentages, Chi-square tests, and binary logistic regression models. The findings were presented as p-values, odds ratios, and 95% confidence intervals.
Results
The prevalence of congenital syphilis was 6% (45 out of 753). In descending order of strength of association, the RPR positive neonates were more likely (p<0.05) to have Fathers who were HIV positive (Chi= 22.871, OR 3.0 [1.12, 7.90]); delivered outside health facilities (Chi =7.885, OR 2.4 [95% CI 0.89, 6.50]); Mothers who were HIV positive (Chi=5.098, OR 1.8 [0.38, 8.59]); present with hypoxia (Chi=4.895, OR 2.5 [95%CI 1.08, 5.55]); delayed first breastfeed (Chi=4.892, OR 2.2 [1.08, 4.39]) and present later at an average chronological age of 20.4days (sd 8.89) compared to their non-Syphilis infected counterparts.
Conclusion
The prevalence of neonatal congenital syphilis remains notably elevated. To mitigate fetal and neonatal morbidity and mortality associated with congenital syphilis, healthcare institutions ought to formulate and advocate for antenatal care initiatives that encompass the involvement of fathers alongside their pregnant partners, in addition to implementing dual rapid diagnostic assessments for both HIV and syphilis. Neonates who present late, particularly those with a concerning medical history, signs of hypoxia, and an initial breastfeeding delay, should be managed with a heightened level of clinical suspicion and without delay.

Neonatal Congenital Syphilis, HIV, Paternal participation.

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