Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS)

Background

Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS).

Methods

Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death.

Results

We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48).

Conclusions

Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.

AB1142 TREATMENT COSTS OF SELECTED RHEUMATIC DISEASES IN SUB-SAHARAN AFRICA: A CASE FOR IMPROVED INSURANCE COVERAGE FOR AFRICAN PATIENTS

Background:

Rheumatic diseases lead to substantial economic costs1especially in resource-poor settings like sub-Saharan Africa (SSA).2Annual direct cost of lupus treatment ranges from $13,735-20,926 /patient in the US to £3231($4232)/patient in the UK.1,3

Data is rare for SSA and Nigeria in particular where the minimum wage is N30,000 ($83/mth) with only 5% of citizens covered by health insurance.4,5The scheme excludes some medications and certain procedures are grossly underfunded. Cost-of-illness studies are invaluable in planning and policy development. They typically include: direct, indirect and intangible costs.6

Objectives:

To compare total costs of some rheumatic diseases, highlight underfunded therapies and push for wider insurance coverage of rheumatic diseases.

Methods:

A cross-sectional study from the University of Uyo Teaching Hospital - Nigeria using data of 252 clinic patients (20 lupus, 27 rheumatoid arthritis, 25 gout and 180 osteoarthritis). Direct costs were estimated using the hospital pricelist while indirect costs were estimated using the human capital method. Statistical analysis was done with p<0.05.

Results:

Females were the majority except for gout patients (44%). Most lupus patients were unemployed (75%) and had the highest annual total cost (N472,800–2,240,400) compared with the others. Key medications excluded from insurance are shown in table 2.

Table 2.

Uninsured treatments.

MMFMethotrexateSulphasalazineAzathioprineHCQFebuxostatColchicineRituximabArthroplasty (N100,000*)Dialysis (6 sessions)Renal transplantTABLE 1.

COST-OF-ILLNESS COMPARISON OF SELECTED RHEUMATIC DISEASES

Lupus (n=20)RA(n=27)Gout(n=25)OA(n=180)Age (years)33.9 ± 11.443.4 ± 14.357.4 ± 9.659.7 ± 9.1Female n (%)24(95)25(92)11(44)157(87)Average Duration of illness (years)4(1-11)3.5(2-10)3 (0.2-8)4(0.1-20)Unemployed n (%)15(75.0)19(70.3)12(48.0)62(34.4)Workdays missed/mth7523Direct costs (N’000)Total /mth (stable)32.42719.7518Total /yr (stable)388.8324237216Total /mth (severe)179.7155.632.523Total /yr (severe)2,156.41,867.2390276Indirect costsProductivity loss/mth7523Productivity loss/yr84602436Total costs/mthTotal costs/yr39.4 – 186.7472.8 – 2,240.432 – 160.6384 – 1.927.221.75 – 34.5261 – 41421 – 26252 – 312

1$ = 360 Nigerian Naira (NGN), 1€ = NGN 402 as at 31/1/2020. Costs quoted in thousands of Naira.

Conclusion:

Total annual cost of lupus treatment in Nigeria is quite high ranging from (NGN 472,800–2,242,400) [$1313- 6228] for mild to severe disease. This contrasts with a mean annual national income of $1,000 given that 75% of lupus patients are unemployed. Expanded insurance coverage for rheumatic drugs will further reduce the enormous treatment burden and improve outcomes.

References:

[1]Slawsky KS et al. A structured literature review of the direct costs of Adult SLE in the US. Arthritis Care Res 2011:63(9); 1224-32.

[2]Adelowo OO. Connective tissue diseases: challenges of management among Nigerians. Annals of Health Research. 2016: 2(2);60-65.

[3]Khamashta M et al. The cost of care of SLE in the UK: Annual direct costs for adult SLE patients with active autoantibody disease. Lupus 2013:23(3):273-83

[4]Uzochukwu BSC et al. Health care financing in Nigeria: Implications for achieving universal health coverage. Nigerian Journal of Clinical Practice. 2015;18(4):437-44.

[5]Nigerian National Minimum Wage.https://tradingeconomics.com/nigeria/minimum-wagesAccessed (31/01/2020).

[6]Zhu TY et al. Cost of illness studies in systemic lupus erythematosus: a systematic review. Arthritis Care Res. 63: 751-760

Acknowledgments:

All study participants, Drs Marvelous Ibanga and Eke Ogudu.

Disclosure of Interests:

None declared

The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria: a controlled trial

The aim of the study was to improve health workers' skills and confidence in dealing with patients with HIV disease and increase attention to patients' human rights. A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management, health education, and attitudinal change toward patients with HIV disease. The intervention group n=1072, control group n=480. Following initial questionnaire-defining focus groups, nurses, laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training. Data were collected in all sites pre-training and 1 y later. Hierarchical multiple regression analysis controlling for baseline data, and orthogonal factor analysis to define scales were used. Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment, attitudes and beliefs about people with HIV disease, less fear and more sympathy for and responsibility toward HIV patients, and an increase in self-perceived clinical skills. There was increased willingness to treat and teach colleagues about people with HIV. Clinician fear and discrimination were significantly reduced, and the climate of fear that was associated with HIV was replaced with a professional concern. There was increased understanding of appropriate psychosocial, clinical and human rights issues associated with HIV treatment and prevention. This intervention, targeting health workers in an entire state and using HIV/AIDS information, role modeling, diffusion of training and discussions of discrimination and human rights, significantly affected the perception of risk groups and behaviors, perceived skills in treatment and counseling, reduced fears and increased concern for people with HIV disease, and improved the climate of treatment and prevention of HIV disease compared with a control state.