Prevalence of Group B Streptococcus maternal colonization, serotype distribution, and antimicrobial resistance in Sub-Saharan Africa: A systematic review and meta-analysis

OBJECTIVE

Group B Streptococcus (GBS)-associated maternal, perinatal, and neonatal mortality and morbidity disproportionately affects Sub-Saharan Africa (SSA). This systematic review and meta-analysis aimed to address the estimated prevalence, antimicrobial susceptibility, and serotype distribution of GBS isolates in SSA.

METHODS

This study was done according to PRISMA guidelines. MEDLINE/PubMed, CINAHL (EBSCO), Embase, SCOPUS, Web of Sciences databases, and Google Scholar were used to retrieve both published and unpublished articles. STATA software version 17 was used for data analysis. Forest plots using the random-effect model were used to present the findings. Heterogeneity was assessed using Cochrane chi-square (I²) statistics, while the Egger intercept was used to assess publication bias.

RESULTS

Fifty-eight studies that fulfilled the eligibility criteria were included for meta-analysis. The pooled prevalence of maternal rectovaginal colonization and vertical transmission of GBS were 16.06, 95% CI [13.94, 18.30] and 43.31%, 95% CI [30.75, 56.32], respectively. The highest pooled proportion of antibiotic resistance to GBS was observed in gentamicin (45.58%, 95% CI [4.12%, 91.23]), followed by erythromycin, (25.11%, 95% CI [16.70, 34.49]). The lowest antibiotic resistance was observed in vancomycin (3.84%, 95% CI [0.48, 9.22]). Our findings indicate that serotypes Ia/Ib/II/ III/and V cover almost 88.6% of serotypes in SSA.

CONCLUSIONS

The estimated high prevalence and resistance to different antibiotic classes observed in GBS isolates from SSA suggests the need for implementation of effective intervention efforts.

Antenatal care and determinants of obstetric danger signs awareness of immediate postpartum women at Buea Regional Hospital, Cameroon

Introduction

a significant proportion of pregnancy related deaths result from delay in decision to seek care and this often stems from failure to identify obstetric danger signs earlier. Early identification of these danger signs will therefore reduce maternal mortality. However, studies on obstetric danger signs awareness are lacking in Cameroon. The objective of this study was to assess the determinants of obstetric danger signs awareness of women at immediate postpartum period. This will inform ANC providers´ practice.

Methods

between June and September 2019, women who delivered at the Buea Regional Hospital were interviewed within 24 hours following their delivery using a researcher-administered questionnaire that covered socio-demographic and obstetric variables. Data were entered into EpiData and analysis done using SPSS 16 and OpenEpi. Statistical significance was set at p-value < 0.05.

Results

of the 532 participants, majority (230/532: 43.2%) were those aged 26-35; danger signs awareness rate was 73.3%. There was a statistically significant relation between age and awareness of obstetric danger signs which showed that older women were more aware than their younger counterparts (p=0.00). Other statistically significant determinants of danger sign awareness included occupation, level of education, parity, trimester of onset of antenatal visits and the number of visits before delivery (p<0.05). Multiparity (370/490: 75.5%) and grand multiparity (14/22: 63.6%) were more likely to be aware of obstetric danger signs than primiparous women (6/20: 30%). Similarly, those who started antenatal visits earlier (first or second trimester) and those who attended more visits were more likely to be aware of obstetric danger signs than their counterparts who started later or had lesser antenatal visits before delivery. The most reported danger signs were severe vaginal bleed (71.4%), fever (62.0%) and reduced fetal movement.

Conclusion

conclusively, more focus should be placed on the sensitisation about obstetric danger signs when in contact with primiparous and younger parturient during ANC visits.