Group B streptococcal colonization as a risk factor for poor neonatal outcomes among pregnant women in labour at Mulago hospital.

Abstract

Background Maternal ano-vaginal Group B Streptococcus (GBS) colonization has been implicated as the cause of fulminant GBS disease in neonates. Despite the proven evidence that vertical transmission of GBS results in poor neonatal outcomes, there is no screening programme for pregnant women in Uganda. Given the high prevalence of neonatal sepsis at Mulago Hospital, (37.5%), it is imperative that proper policies are streamlined to ensure pregnant women are screened, thereby reducing the risk of fulminant disease in the neonate. Specific Objectives 1. To determine the prevalence of ano-vaginal Group B streptococcus amongst women in labour at Mulago Hospital. 2. To determine risk factors for GBS colonization in a pregnant woman in labour. 3. To determine the magnitude of GBS as a risk factor for adverse neonatal outcomes among women in labour at Mulago hospital. Methods This was a cohort study involving 644 women in labour at Mulago Hospital. Informed consent was sought, questionnaires filled and ano-vaginal samples taken. Samples were taken to the Department of Microbiology, Makerere University for culture and antibiotic sensitivity. Every twentieth sample was taken to MBN Labs for quality assurance. Two telephone interviews were conducted on the 3rd and 6th post-delivery day and the participants were asked to report to the hospital on the 8th post-delivery day for analysis of neonatal and maternal outcomes. Blood samples were withdrawn from the babies of GBS positive mothers, for culture.

Results The prevalence of maternal GBS colonization was 5.0%(32/644). Maternal GBS was associated with being a teenage mother; p=0.041 OR 0.41(0.18-0.97). No neonate recorded fulminant GBS disease after blood culture, however 75% (24/32) recorded symptoms of neonatal sepsis. Resistance to erythromycin, the main drug used in Mulago Hospital, was found to be 31.3%. Conclusions Since teenage mothers are mostly affected in this study, it is recommended that government implements a GBS screening programme for pregnant teenagers. Clindamycin, instead of erythromycin is recommended as a drug of choice for the prophylactic management of GBS in women in labour.