Prevalence of Syphilis and determinants among Female Sex Workers in Ethiopia: A Multilevel Analysis of the National Bio-behavioral Survey Data Using Respondent Driven Sampling

Abstract

Background: Syphilis is a highly contagious Sexually Transmitted Infection posing a significant public health challenge, especially in developing countries including those in 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. There is scarce data on national syphilis prevalence estimate and the associated factors in Ethiopia. This along with our limited knowledge extent of clustering among female sex workers across towns in the country, a critical gap in information we aimed to fill through this analysis. Methods: The study was a community based cross-sectional, bio-behavioral survey conducted among FSWs in 16 cities and major towns in Ethiopia by using a Respondent Driven Sampling method. Survey data were collected through an interviewer administered questionnaire and blood samples were collected for syphilis, HIV, and hepatitis serological testing from 6085 participants. In this analysis, we employed descriptive statistics to summarize data on the study variables. We used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the outcome (syphilis prevalence), while also accounting for the clustering effect. Result: Of the 6085 female sex workers included in the study, a majority (96.1%) were in the 20-24 years age group. The overall prevalence of syphilis among female sex workers in the 16 cities and major towns of Ethiopia 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 infection among female sex workers. Conclusion: The prevalence of syphilis was high among female sex workers in Ethiopia. Being divorced/widowed or in the older age group, and having low level of education were significantly associated with increased risk of syphilis. The high prevalence and the determinant identified in the study need to be considered in the planning of comprehensive interventions to control syphilis infection among female sex workers in Ethiopia.