1
|
Tesfaye A, Fekede M, Getu F, Mekuria S, Abebe T, Tollosa D, Barsenga S, Tahir B, Kedir Roble A, Tesfaye S, Walle M. Vertical Transmission of Group B Streptococcus, Prevalence, Associated Factors, and Antimicrobial Susceptibility Profile among Newborns Delivered at Health Facilities in Jigjiga City, Ethiopia. Int J Microbiol 2024; 2024:5673366. [PMID: 39129911 PMCID: PMC11316908 DOI: 10.1155/2024/5673366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/09/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Background Group B Streptococcus (GBS) colonizes the rectovaginal area of women and vertically transmitted to neonates. This bacterium has been linked to severe neonatal complications including pneumonia, septicemia, and meningitis. GBS shows an increased resistance to commonly used antibiotics. Thus, we assessed the vertical transmission, contributing factors, and antimicrobial resistance patterns of GBS among newborns delivered at selected Hospitals in Jigjiga City. Methods Hospital-based cross-sectional study was conducted from 1st June 2022 to 30th April 2023. A total of 849 pregnant women admitted to delivery wards from two hospitals were screened for GBS colonization. Subsequently, 162 GBS-colonized pregnant women and their newborn babies were included. A semistructured questionnaire and a review of medical records were used to collect the sociodemographic and clinical characteristics of the study participants. Trained nurses collected swab samples from the vaginal-rectal area of pregnant women and the nasal, ear canal, and umbilical areas of newborn babies. Samples were inoculated on Todd Hewitt broth media supplemented with gentamycin and nalidixic acid and then subcultured on blood agar. Colony characteristics, Gram stain, and catalase test were used for identification. All gram-positive cocci, B-hemolytic, and catalase-negative isolates were further identified using Christie-Atkins-Munch-Petersen and a bacitracin test. The modified Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. Data were analyzed using SPSS version 26. Logistic regression analysis was used to determine the factors associated with vertical transmission of GBS, and statistical significance was set at p values <0.05. Result The overall vertical transmission rate was 41.4% (67/162). History of preterm labor (Adjusted odds ratio (AOR) = 2.25; 95% CI: 1.11, 4.59), history of urinary tract infection (UTI) at current pregnancy (AOR = 2.25; 95% CI: 1.11, 4.59), and prolonged rupture of membranes greater than 18 hours (AOR = 2.23; 95% CI: 1.13, 4.4) were significantly associated with vertical transmission of GBS from previously colonized mothers to their newborn babies. Regarding GBS antibiotic susceptibility profile, a significant degree of resistance was observed to penicillin (29.9%), tetracycline (22.4%), ampicillin (20.9%), and clindamycin (19.4%). Conclusion Our study documented a high prevalence of vertical transmission rate of GBS from pregnant women to their babies, with an overall transmission rate of 41.4%. The study identified the presence of antimicrobial-resistant GBS to penicillin, ampicillin, clindamycin, ciprofloxacin, and chloramphenicol. The organism was susceptible to vancomycin, followed by azithromycin, ceftriaxone, and erythromycin. Our study also reported MDR at 13.4%. Based on our findings, there is a need for antenatal culture-based GBS screening, maternal vaccination, and large-scale epidemiological and serotype identification studies to be put into practice in the study area.
Collapse
Affiliation(s)
- Addisu Tesfaye
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Mahlet Fekede
- Department of PediatricsCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Fasil Getu
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Surafel Mekuria
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Tigist Abebe
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Daniel Tollosa
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Shamil Barsenga
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Bawlah Tahir
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Abdurahman Kedir Roble
- Department of MidwiferySchool of NursingCollege of Medicine and Health ScienceJigjiga University, Jigjiga, Ethiopia
| | - Sara Tesfaye
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Muluken Walle
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| |
Collapse
|
2
|
Abdelmola A. Antenatal Care Services in Sudan Before and During the 2023 War: A Review Article. Cureus 2023; 15:e51005. [PMID: 38259390 PMCID: PMC10803029 DOI: 10.7759/cureus.51005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Antenatal care (ANC) is provided by skilled healthcare professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy. It includes risk identification, prevention, management of pregnancy-related diseases, health education, and health promotion. Antenatal care has a great effect on vital health indicators such as maternal and neonatal mortality by identifying and treating pregnancy-related complications. Political instability and armed conflict have seriously affected the health system, which has catastrophic implications for pregnant women's health. This review aimed to summarize the literature on ANC in Sudan before and during political instability and war by highlighting its effect on maternal mortality, coverage, care providers, quality of care, accessibility, and utilization. Other aspects of this review are the ANC components and service provision during the war. In addition, the author tried to identify the gaps and point out the future research needs in Sudan. A total of 58 articles about ANC in Sudan have been reviewed through PubMed, Google Scholar, ResearchGate databases, and other search tools. The keywords used were "antenatal care", "coverage", "service providers", "service quality", "accessibility and utilization", "components", and "ANC during the war". All the keywords were followed by "Sudan" to confine the search. According to the reviewed data, ANC services in Sudan, even during normal political situations, were not sufficient and of poor quality in most of the reviewed regions. The political instability and armed conflicts worsened the situation, and it became catastrophic. To improve the accessibility and quality of ANC services, we will need the collaboration of all stakeholders to address the health needs of vulnerable groups, people in remote rural areas, and nomadic communities towards providing the required health services in general and ANC in particular. On the other hand, an important aspect of this development is the availability of skilled healthcare providers and the adoption, revision, and updating of working procedure guidelines to match the needs of the local communities. The main shareholders are the local communities; they must be empowered and involved by raising their awareness. Then, effective, punctual, and applicable contingency plans should be ready for any unfortunate crises.
Collapse
|
3
|
Ropero Alvarez AM, Vilajeliu A, Magariños M, Jauregui B, Guzmán L, Whittembury A, Cain E, Garcia O, Montesanos R, Ruiz Matus C. Enablers and barriers of maternal and neonatal immunization programs in Latin America. Vaccine 2020; 39 Suppl 2:B34-B43. [PMID: 32943263 DOI: 10.1016/j.vaccine.2020.07.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/24/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Region of the Americas has a long history of implementing maternal and neonatal immunization (MNI) programs. Our study aimed to understand the state of MNI policies, strategies and implementation practices in Latin America (LA). METHODS Study conducted in 5 middle-income countries: Argentina, Brazil, Honduras, Mexico and Peru. The methods included a desk review, interviews with national stakeholders and health care providers, focus groups with pregnant women and observations in health facilities. Enablers and barriers were identified and categorized as individual, societal or related to the health system. RESULTS All 5 participating countries had similar MNI policies and high access to antenatal care. Key enablers were the high acceptability of vaccination during pregnancy, high-level of political will and a national legal framework ensuring free access to vaccines. At the health system level, implementation was facilitated by the existence of immunization advisory committees, a pooled vaccine procurement mechanism, complementary vaccine delivery strategies, conditional cash transfer to users and performance incentives to health facilities. The main programmatic barriers were the lack of adequate MNI information; limited coordination between antenatal and immunization services; inadequate supply, resources and infrastructure; high staff turnover; insufficient training for health care providers; and weak monitoring and reporting systems. CONCLUSION Middle-income countries in LA have successfully implemented MNI programs and several enablers were identified. To overcome remaining barriers, there is a need to focus on improving the "immunization journey" for pregnant women through providing more clear and timely information to users and providers; removing barriers to access; ensuring adequate supply, human resources and infrastructure; making the health service experience positive; and establishing integrated information systems that allow for monitoring the progress toward achieving MNI goals. Strengthening the MNI programs can also improve equitable access to health services and prepare for the introduction of future vaccines for pregnant women.
Collapse
Affiliation(s)
- Alba Maria Ropero Alvarez
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, Washington DC, USA.
| | - Alba Vilajeliu
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, Washington DC, USA.
| | - Mirta Magariños
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, PAHO Country Office in Argentina, Buenos Aires, Argentina
| | - Barbara Jauregui
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, Washington DC, USA
| | - Lely Guzmán
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, PAHO Country Office in Brazil, Brazilia, DF, Brazil.
| | - Alvaro Whittembury
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, PAHO Country Office in Ecuador, Quito, Ecuador.
| | - Emilia Cain
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, PAHO Country Office in Mexico, Mexico City, Mexico.
| | - Odalys Garcia
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, PAHO Country Office in Honduras., Tegucigalpa, Honduras.
| | - Raul Montesanos
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, PAHO Country Office in Peru, Lima, Peru.
| | - Cuauhtemoc Ruiz Matus
- Comprehensive Family Immunization Unit, Department of Family, Health Promotion, and Life Course (FPL), Pan American Health Organization (PAHO) / WHO Regional Office for the Americas, Washington DC, USA.
| | | |
Collapse
|
4
|
Giles ML, Mantel C, Muñoz FM, Moran A, Roos N, Yusuf N, Diaz T, Ahun M, Nic Lochlainn LM, Wootton E, Pathirana J, Rendell S, Tuncalp O, Perut M, Hombach J, Merten S, Lambach P. Vaccine implementation factors affecting maternal tetanus immunization in low- and middle-income countries: Results of the Maternal Immunization and Antenatal Care Situational Analysis (MIACSA) project. Vaccine 2020; 38:5268-5277. [PMID: 32586763 PMCID: PMC7342017 DOI: 10.1016/j.vaccine.2020.05.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the characteristics of existing maternal tetanus immunization programmes for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with maternal vaccine service delivery that may impact the introduction and implementation of new maternal vaccines in the future. DESIGN A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits. SETTING LMICs. RESULTS The majority of countries (84/95; 88%) had a maternal tetanus immunization policy. Countries with high protection at birth (PAB) were more likely to report tetanus toxoid-containing vaccine (TTCV) coverage targets > 90%. Less than half the countries included in this study had a TTCV coverage target of > 90%. Procurement and distribution of TTCV was nearly always the responsibility of the Expanded Programme on Immunization (EPI), however planning and management of maternal immunization was often shared between EPI and Maternal, Newborn and Child Health (MNCH) programmes. Receipt of TTCV at the same time as the antenatal care visit correlated with high PAB. Most countries (81/95; 85%) had an immunization safety surveillance system in place although only 11% could differentiate an adverse event following immunization (AEFI) in pregnant and non-pregnant women. CONCLUSIONS Recommendations arising from the MIACSA project to strengthen existing services currently delivering maternal tetanus immunization in LMICs include establishing and maintaining vaccination targets, clearly defining responsibilities and fostering collaborations between EPI and MNCH, investing in strengthening the health workforce, improving the design and use of existing record keeping for immunization, adjusting current AEFI reporting to differentiate pregnant women and endeavoring to integrate the provision of TTCV within ANC services where appropriate.
Collapse
Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| | - C Mantel
- MMGH Consulting, Zurich, Switzerland
| | - F M Muñoz
- Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston TX, USA
| | - A Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland
| | - N Roos
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland
| | - N Yusuf
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - T Diaz
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland
| | - M Ahun
- Independent Consultant, McKing Consulting, Geneva, Switzerland
| | - L M Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - E Wootton
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - J Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/ National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Rendell
- Department of Anthropology University of Pennsylvania, Philadelphia, USA
| | - O Tuncalp
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - M Perut
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - J Hombach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - S Merten
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - P Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| |
Collapse
|
5
|
Giles ML, Mason E, Muñoz FM, Moran AC, Lambach P, Merten S, Diaz T, Baye M, Mathai M, Pathirana J, Rendell S, Tunçalp Ö, Hombach J, Roos N. Antenatal care service delivery and factors affecting effective tetanus vaccine coverage in low- and middle-income countries: Results of the Maternal Immunisation and Antenatal Care Situational analysis (MIACSA) project. Vaccine 2020; 38:5278-5285. [PMID: 32527598 PMCID: PMC7342001 DOI: 10.1016/j.vaccine.2020.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/31/2023]
Abstract
Objectives To map the integration of existing maternal tetanus immunization programmes within antenatal care (ANC) services for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with high performance maternal vaccine service delivery. Design A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits was undertaken between 2016 and 2018. Associations of different service delivery process components with protection at birth (PAB) and with country groups were established. PAB was defined as the proportion of neonates protected at birth against neonatal tetanus. Regression analysis and structural equation modelling was used to assess associations of different variables with maternal tetanus immunization coverage. Latent class analysis (LCA), was used to group country performance for maternal immunization, and to address the problem of multicollinearity. Setting LMICs. Results The majority of LMICs had a policy on recommended number of ANC visits, however most were yet to implement the WHO guidelines recommending eight ANC contacts. Countries that recommended > 4 ANC contacts were more likely to have high PAB > 90%. Passive disease surveillance was the most common form of disease surveillance performed but the maternal and neonatal morbidity and mortality indicators recorded differed between countries. The presence of user fees for antenatal care and maternal immunization was significantly associated with lower PAB (<90%). Conclusions Recommendations include implementing the current WHO ANC guideline to facilitate increased opportunities for vaccination during each pregnancy. Improved utilisation of ANC services by increasing the demand side by increasing the quality of services, reducing any associated costs and supporting user fee exemptions, or the supply side can also enhance utilisation of ANC services which are positioned as an ideal platform for delivery of maternal vaccines.
Collapse
Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| | - E Mason
- London School of Hygiene and Tropical Medicine, London, UK
| | - F M Muñoz
- Section Infectious Diseases, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - A C Moran
- Epidemiology, Monitoring and Evaluation (EME), Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - P Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - S Merten
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - T Diaz
- Epidemiology, Monitoring and Evaluation (EME), Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - M Baye
- Coordinator of the National Program to Combat Maternal, Newborn and Child Mortality, Ministry of Public Health, Cameroon
| | - M Mathai
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Rendell
- Department of Anthropology, University of Pennsylvania, Philadelphia, USA
| | - Ö Tunçalp
- Department of Sexual and Reproductive Health and Research Including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Geneva, Switzerland
| | - J Hombach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - N Roos
- Karolinska Institutet, Department of Medicine, Clinical Epidemiology Division, Stockholm, Sweden
| |
Collapse
|
6
|
Krishnaswamy S, Lambach P, Giles ML. Key considerations for successful implementation of maternal immunization programs in low and middle income countries. Hum Vaccin Immunother 2019; 15:942-950. [PMID: 30676250 PMCID: PMC6605837 DOI: 10.1080/21645515.2018.1564433] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
The Maternal Neonatal Tetanus Elimination program is proof of concept for the feasibility and potential for maternal immunization to reduce neonatal mortality particularly in low and middle-income countries. Introduction of any additional vaccine into the antenatal space, such as Influenza and Pertussis, and potentially Respiratory Syncytial Virus and Group B Streptococcus vaccines in the future, requires strengthening of antenatal care and immunization services. Successful implementation also requires robust disease surveillance in pregnant women and neonates and active surveillance for adverse events following immunization to monitor the impact and ensure the safe use of the vaccine. This review outlines five key elements essential for successful implementation of a maternal immunization program focusing particularly on low and middle-income countries. These include; relevant considerations in supporting a decision to undertake a maternal immunization program including knowledge of local disease epidemiology, involvement of the consumer, healthcare provider recommendation, equitable access to maternal vaccination, and systems for disease surveillance, program evaluation and safety monitoring.
Collapse
Affiliation(s)
- Sushena Krishnaswamy
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Michelle L. Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| |
Collapse
|