Academic journal article Bulletin of the World Health Organization

Adverse Birth Outcomes in United Republic of Tanzania-Impact and Prevention of Maternal Risk factors/Issues Defavorables De L'accouchement En Tanzanie-Influence et Prevention Des Facteurs De Risque maternels/Desenlaces Adversos del Parto En la Republica Unida De Tanzania: Impacto Y Prevencion De Los Factores De Riesgo Maternos

Academic journal article Bulletin of the World Health Organization

Adverse Birth Outcomes in United Republic of Tanzania-Impact and Prevention of Maternal Risk factors/Issues Defavorables De L'accouchement En Tanzanie-Influence et Prevention Des Facteurs De Risque maternels/Desenlaces Adversos del Parto En la Republica Unida De Tanzania: Impacto Y Prevencion De Los Factores De Riesgo Maternos

Article excerpt

Introduction

Adverse birth outcomes such as low birth weight (LBW) and prematurity are associated with increased infant morbidity and mortality. (1) Maternal risk factors that are likely to be particularly important in sub-Saharan Africa include reproductive tract infections (RTIs), malaria and human immunodeficiency virus (HIV) infection. (2-5) The impact of these infections is likely to be high because they are so prevalent. Up to 50% of stillbirths, for example, have been attributed to untreated maternal syphilis. (6,7) Other RTIs associated with adverse birth outcomes include bacterial vaginosis (BV), gonorrhoea, and Chlamydia trachomatis and Trichomonas vaginalis infections. (8-12)

A few studies have documented other maternal factors associated with adverse pregnancy outcomes in sub-Saharan Africa. (13-20) However, there are few data on the examination of multiple determinants of birth outcome and the proportion of adverse birth events attributable to these factors from the study region, partly because of a lack of simple, inexpensive diagnostic methods.

We conducted a study to determine the effectiveness of syphilis screening and treatment in preventing adverse pregnancy outcomes in women in Mwanza city, north-west United Republic of Tanzania. (21) This study allowed the concomitant measurement of the importance and impact of other maternal factors in this population.

Methods

Study design and participants

The study methods have been described in detail elsewhere. (21) In summary, a prospective cohort of 1688 women attending an antenatal clinic (ANC) was recruited from the main ANC in Mwanza city from 1997 to 2000 to examine the effectiveness of antenatal screening and treatment of syphilis. Women were screened at the ANC for syphilis by the rapid plasma reagin assay (RPR). RPR-positive women were treated with a stat dose of benzathine penicillin G, 2.4 MU, by intramuscular injection. Inclusion criteria for enrolment included informed consent, residence in Mwanza city for at least 1 month and a viable pregnancy confirmed by ultrasound. Exclusion criteria included more than one fetus or congenital fetal abnormality seen on ultrasound, maternal diabetes, hypertension or a history of vaginal bleeding in the current pregnancy. For each RPR-positive woman consecutively enrolled, the next two RPR-negative eligible women were recruited. Women were interviewed about their sociodemographic characteristics, obstetric history, RTI symptoms and recent antibiotic treatment. On examination, vaginal and cervical specimens were collected. Women diagnosed with T. vaginalis and/or Candida albicans on vaginal wet preparations were offered immediate treatment. ANC attendees were provided with iron and folate supplements and chloroquine 300-mg base following the Tanzanian national guidelines at that time. At a follow-up visit 2 weeks later, participants were treated for any RTIs identified in reference laboratory tests done following national guidelines. Syphilis testing was repeated at the STD reference laboratory in Mwanza. Women who were RPR-negative following the initial ANC screening, but who were found to be RPR-reactive at the reference laboratory were treated with benzathine penicillin G, 2.4 MU, by intramuscular injection.

A second RTI screen and treatment and an ultrasound examination were offered to women recruited before 32 weeks gestation. Free treatment was offered to the sexual partners of women with RTIs. Participants were followed to delivery. As soon as possible after admission, a 10-ml venous blood sample and a finger-prick sample for a malaria thick film and haematocrit were collected. A placental blood smear and a 10 [mm.sup.3] placental biopsy from the maternal placental surface were taken after delivery. Data were collected on birth outcomes and signs of congenital syphilis. Stillbirth was defined as a fetal death after 22 weeks gestation, intrauterine fetal death (IUFD) as fetal death at or before 22 weeks gestation, LBW as birth weight less than 2500 g, prematurity as delivery before 37 weeks gestation and intrauterine growth retardation (IUGR) as an LBW infant born at or after 37 weeks gestation. …

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