Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Wollo University, Addis Ababa, Ethiopia.
BMC Public Health. 2023 May 3;23(1):809. doi: 10.1186/s12889-023-15745-1.
Syphilis is a highly contagious sexually transmitted infection posing a significant public health challenge, especially in developing countries, including sub-Saharan Africa. Female sex workers are exposed to sexually transmitted infections, including syphilis, because of their sexual behavior and limited access to health services. However, data on national syphilis prevalence estimates and the associated factors are scarce in Ethiopia. This, as well as our limited knowledge about the extent of clustering among female sex workers in the country, is a critical gap in information we aimed to fill through this analysis.
The study was a cross-sectional, bio-behavioral survey conducted among female sex workers in six cities and ten major towns in Ethiopia. Participants were selected using a respondent-driven sampling method. Survey participants provided blood samples for syphilis, HIV, and hepatitis serological testing. Survey data were collected via an interviewer-administered questionnaire. In this analysis, we employed descriptive statistics to summarize data on the study variables. In addition, we used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the dependent variable (syphilis prevalence) while accounting for the clustering effect.
A total of 6085 female sex workers participated in the survey. Their median age [Interquartile Range (IQR) was 25 (8)] years, and a majority (96.1%) were in the 20-24-year-old age group. The prevalence of syphilis among female sex workers in Ethiopia's six cities and ten major towns was 6.2%. Being in the age group of 30-34 (AOR = 2.64; 95% CI = 1.40, 4.98) and 35-59 (AOR = 4.7; 95% CI = 2.5, 8.86), being divorced/widowed (AOR = 1.37; 95% CI = 1.03, 1.82), having no formal education (AOR = 3.38; 95% CI = 2.34, 5.11), primary 1st cycle (grades 1-4) education (AOR = 2.77; 95% CI = 1.79, 4.30), and having primary 2nd cycle (grades 5-8) education (AOR = 1.80; 95% CI = 1.21, 2.69) were significantly associated with syphilis among female sex workers.
The prevalence of syphilis among female sex workers was high. Being divorced/widowed or in the older age group and having a low level of education were significantly associated with an increased risk of syphilis. The high prevalence and associated factors identified need to be considered in planning comprehensive interventions to control syphilis among female sex workers in Ethiopia.
梅毒是一种高度传染性的性传播感染，对包括撒哈拉以南非洲在内的发展中国家构成重大公共卫生挑战。性工作者由于其性行为和获得卫生服务的机会有限，容易接触到性传播感染，包括梅毒。然而，埃塞俄比亚全国梅毒流行率估计和相关因素的数据稀缺。这以及我们对该国性工作者之间聚类程度的了解有限，是我们通过这项分析旨在填补的信息空白。
这项研究是在埃塞俄比亚六个城市和十个主要城镇的性工作者中进行的横断面、生物行为调查。参与者采用回应者驱动抽样方法选择。调查参与者提供梅毒、艾滋病毒和肝炎血清学检测的血液样本。调查数据通过访谈者管理的问卷收集。在这项分析中，我们采用描述性统计来总结研究变量的数据。此外，我们还使用多水平双变量和多变量逻辑回归模型来检查独立变量与因变量（梅毒流行率）之间的关联，同时考虑到聚类效应。
共有 6085 名性工作者参加了调查。她们的中位年龄[四分位距（IQR）为 25（8）]，大多数（96.1%）年龄在 20-24 岁。埃塞俄比亚六个城市和十个主要城镇的性工作者中梅毒的流行率为 6.2%。年龄在 30-34 岁（AOR=2.64；95%CI=1.40,4.98）和 35-59 岁（AOR=4.7；95%CI=2.5,8.86）、离婚/丧偶（AOR=1.37；95%CI=1.03,1.82）、没有正式教育（AOR=3.38；95%CI=2.34,5.11）、小学 1 周期（1-4 年级）教育（AOR=2.77；95%CI=1.79,4.30）和小学 2 周期（5-8 年级）教育（AOR=1.80；95%CI=1.21,2.69）与性工作者中的梅毒显著相关。
性工作者中梅毒的流行率很高。离婚/丧偶或年龄较大以及受教育程度较低与梅毒风险增加显著相关。需要考虑到所确定的高流行率和相关因素，以规划综合干预措施来控制埃塞俄比亚性工作者中的梅毒。
