The impact of treatment adequacy and infection severity on preterm birth outcomes among syphilis-positive women in Botswana using multilevel logistic regression model

Syphilis is one of the most prevalent sexually transmitted infections globally, and millions of cases are reported annually. Despite the established availability of screening and treatment services for syphilis at antenatal care, women still experience adverse perinatal outcomes. Therefore, this study examines the impact of treatment adequacy and infection severity on preterm birth outcomes among syphilis-positive women in Botswana using a multilevel logistic regression model. The proposed model aims to yield refined and context-specific findings that not only support improved maternal and child health outcomes but also offer valuable insights for implementing person-centered strategies in line with the Global Health Sector Strategy. This study used a retrospective cohort design involving 660 syphilis seropositive pregnant women from 2020 to 2023. Data were extracted from antenatal and maternity records in the Ministry of Health’s National Data Warehouse (NDW) for all syphilis positive pregnant women. The data were structured into two (2) levels, with individuals(women) nested within health districts. A multilevel logistic regression model (2-level) was used to model the association between maternal syphilis and the risk of preterm birth. Results showed that women who received at least one dose of penicillin treatment had a 65% reduction in chances of having a preterm birth (AOR = 0.349, CI = 0.159–0.766), while women who received two (2) to full treatment (three (3) doses) had a 78% reduction chance (AOR = 0.224, CI = 0.086–0.586). The results provide strong evidence for strengthening syphilis screening protocols and ensuring timely and complete treatment for pregnant women. To reduce the burden of congenital syphilis and improve maternal and neonatal health outcomes, in line with global health strategies, this study reinforces the urgent need for timely intervention and a person-centred approach in managing maternal syphilis. Investing in early detection and treatment programs will not only save lives but also contribute to broader maternal and child health targets in Botswana and similar settings.