Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Príncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1-3 (inadequate), 4-7 (adequate), and ≥8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value ≤0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers' mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1-3 ANC contacts, 46.4% (237) had 4-7 and 38.7% (198) ≥8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (p<0.001) for the complete ANC group when compared to other groups. Antenatal problems identified were: 1) bacteriuria (43.2%); 2) maternal anemia (37%); 3) intestinal parasitic infections (59.2%); 4) sickle cell solubility test positive (13%); and 5) a RhD-negative phenotype (5.8%). Missed-ANC treatments were up to 50%. This study reveals a coverage-quality gap in STP since no pregnant woman is left without ANC contact, although most still miss evidence-based screenings with an impact on neonatal outcomes. Strategies such as implementing a total free ANC screening package in STP would enhance maternal diagnosis and prompt treatments.
Abstract Background Up to 70% of pregnant women in Africa have an intestinal parasitic infection (IPI), but the associated adverse birth outcomes (ABOs) remain unclear, with gaps to be addressed. IPI prevalence among pregnant women in Sao Tome & Principe (STP) was found to be up to 60%, mainly due to Ascaris lumbricoides . Schistosoma intercalatum and Entamoeba histolytica IPIs were also identified. Despite this high-IPI prevalence, the impact of IPIs on maternal and neonatal health is unknown and has never been studied in STP. Therefore, this study sought to identify whether there were ABOs, including maternal anaemia (haemoglobin <11 g/dL), preterm birth (PTB) for gestational age <37 weeks, low birth weight (LBW) <2500 g and stillbirths associated with pregnant women with an IPI compared to their noninfected counterpart. Methods A hospital-based cross-sectional study was conducted among pregnant women admitted for delivery at the only maternity hospital in STP. Only women with an antenatal care (ANC) copro-parasitological screening were included. Pregnant women with HIV, sickle cell, malaria and STHs who were adequately treated were excluded. Data were abstracted from ANC pregnancy cards, newborns’ medical records, and a structured face-to-face interviewer-administered questionnaire. Pregnant women with an IPI (n=210) were compared to noninfected women (n=151). Subgroup analyses were conducted comparing ABOs in noninfected (no-IPI group) with ABOs in i ) monoparasitic-IPI (n=145), ii ) polyparastic-IPI (n=25), iii ) STHs (n=162), iv ) S intercalatum (n=11), and v ) E histolytica (n=7). Data analysis was performed using SPSS version 25.0. Chi-square and Fisher´s exact tests were used to identify associations between ABOs and IPI in pregnant women at p value <0.05. Results A total of 361 women with a mean age of 26.96 (SD: 7.00) were included, 43.6% (156) practiced open defecation, 15.8% (57) had no access to improved water, and 53.6% (192) lived in a rural area. The ABOs identified were 127 (39.6%) maternal anaemia, 26 (8.1%) PTB, 48 (14.9%) LBW and 8 (2.5%) stillbirths. ABOs in the monoparasitic-IPI and no-IPI groups were 46.7% vs 38.7% maternal anaemia, 6.2% vs 10.6% PTB, 11% vs 19.2% LBW and 3.4% vs 1.3% stillbirth, respectively. No statistically significant difference ( p 0.182, p 0.175, p 0.07, p 0.275) was found between the two groups. ABOs for S. intercalatum were anaemia 4 (36.4%) and LBW 1 (9.1%). A statistically significant difference was not found between ABOs in the no-IPI group compared to S. intercalatum or to other IPI-subgroups (polyparasitic-IPI, STHs, and E. histolytica ). Conclusion Maternal anaemia was found in almost half of pregnant women, but an association with IPI was not established. ABOs-related to IPIs are linked to the type of parasite, pathogenesis, intensity, and timing of the infection. Thus, the predominant parasite type – Ascaris lumbricoides – a low pathogenicity parasite, can support this study´s lack of association between IPIs and ABOs. Therefore, it is very important to know the country specific-setting of IPI epidemiology. To achieve a schistosomiasis elimination status, women-of-reproductive age and pregnant women should be included in the country preventive chemotherapy programmes.
Abstract Background: Newborn mortality in Sao Tome and Principe (STP) is overwhelmingly high and the antenatal healthcare (ANC) is one of the strategies to achieve its reduction. This study aimed to know which antenatal screenings are done in STP and which antenatal problems are detected. Methods: A retrospective study in which 518 pregnant women antenatal cards were reviewed between July 2016 and November 2018. Information analysed included clinical factors, laboratory tests, ultrasounds, results, and treatment. Results: Mothers’ mean age was 26.6 (SD=7.1) years old. At least one ANC visit occurred in 98.6% pregnant women and 38.7% had 8 or more. Regarding laboratory screenings, blood group was done in 64.4%, haemoglobin tested in 62.5% (first trimester) and in 29.3% (second trimester) and, urine once in 57.1% and twice in 12.2%. Antenatal problems identified in the pregnant women studied were: i) a RhD-negative phenotype (5.8%); 2) anaemia 1 st trimester (36.4%) and 2 nd trimester (35.5%); 3) bacteriuria (43.2%); 4) intestinal parasites (55.5%); 5) sickle cell solubility test positive (13%). Overall, 161 (53.7%) out of the 300 ultrasounds were done before the 20th week. Conclusion: In Sao Tome and Principe many pregnant women do not have access to the full spectrum of ANC recommended screenings. Maternal anaemia and bacteriuria are the main health problems that should be urgently addressed to prevent newborn morbidity and mortality in the country. Other preventive interventions as anthelmintic drugs should be debated as intestinal parasites were diagnosed in more than half of the women. Alloimmunization to RhD is also a concern due to the unaffordability of anti-D immunoglobulin in the country.
Abstract Background Newborns with one or more adverse birth outcomes (ABOs) are at greater risk of mortality or long-term morbidity with health impacts into adulthood. Hence, identifying ABO-associated factors is crucial for devising comprehensive and relevant interventions. The aim of this study was to identify factors that are associated with the occurrence of ABO – prematurity (PTB), low birth weight (LBW), macrosomia, congenital anomalies, asphyxia, and sepsis - among babies delivered at the only hospital of Sao Tome & Principe (STP), a resource-constrained sub-Saharan Western African country. Methods Hospital-based unmatched case‒control study conducted in STP among newborns from randomly selected mothers from July 2016 to November 2018. Newborns with one or more ABO (gestational age <37 weeks, LBW < 2.5 kg, BW >4 kg, 5-minute Apgar score <7, major congenital anomalies, and probable sepsis based on clinical criteria) were the cases (ABO group), while healthy newborns without ABO were the controls (no-ABO group). Data were collected by a face-to-face interview and abstracted from antenatal pregnancy cards and medical records. Multivariable logistic regression analysis was performed to identify ABO risk factors considering a level of significance α=0.05. Results A total of 519 newborns (176 with ABO and 343 with no-ABO) were enrolled. The mean gestational age and birth weight of cases and controls were 36 (SD=3.7) weeks with 2659 (SD=881.44) g and 39.6 (SD=1.0) weeks with 3256 (SD=345.83) g, respectively. In a multivariable analysis, twin pregnancy [aOR 4.92, 95% CI 2.25–10.74], prolonged rupture of membranes [aOR 3.43, 95% CI 1.69–6.95], meconium-stained amniotic fluid [aOR 1.59, 95% CI 0.97-2.62], and fewer than eight antenatal care (ANC) visits [aOR 0.33, 95% CI 0.18–0.60] were significantly associated with adverse birth outcomes. Conclusion Modifiable factors were associated with ABOs in this study and should be considered in cost-effectiveness interventions. The provision of high-quality ANC with eight or more visits should be a priority at ANC service delivery in STP. Twin pregnancies as well as intrapartum factors such as prolonged rupture of membranes and meconium-stained amniotic fluid are red flags for adverse birth outcomes that should receive prompt intervention and follow-up.
Background Neonatal deaths in São Tomé and Príncipe account for about 43% of all under-5 deaths, but there are major gaps in understanding this. The objective of this study was to identify ante-, intra-, and post-partum risk factors and to analyse characteristics of neonatal morbimortality. Methods Stillbirths and sick newborns (NB) with ≥32 week´s gestation or ≥1500 g were eligible cases, while controls were healthy newborns≥28 days. The study is still underway, and more data will become available. Results presented here are from a questionnaire applied by the investigator, and from medical records of mothers and newborns. Point-of-care tests were used to screen for syphilis, HIV and Hepatitis B. The SPSS 23 statistical programme was used for data analysis. Informed consent was obtained from every mother included in the study. Results Out of 675 mothers, 132 were enrolled corresponding to 134 newborns (2 twins), while 35 cases and 41 newborn controles were followed up. Pregnant women’s medium age was 26 years, 23% being adolescents and 23% without antenatal care. Primary education was attended by 57%, secondary by 63%, 7% never attended school. Syphilis – 1/96 reactive test; HIV or malaria not detected; 3 infected with HBV. Newborn morbimortality: 10 preterm, 12 birth asphyxia, 30 with risk of neonatal and 8 with invasive infections, 8 foetal growth restriction, 5 microcephaly, 4 minor congenital anomalies and 1 death in the first 24 hours of life (congenital lung anomaly). Low birth weight (<2500 g), meconium and caesarean section were statistically significant with respect to morbidity (p<0.05). No deaths were verified in the 76 babies followed up. Conclusion In this study, newborn morbidity was high (59%). More conclusions will be drawn when a higher number of participants is included and analysed. As a result, at the completion of this study, we hope to be able to design an intervention algorithm in order to achieve peri-neonatal morbimortality reduction.
Background Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country. Methods Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life ( n = 194) for identification of neonatal death-outcome ( n = 22) and alive-outcome groups ( n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value <0.05 was considered statistically significant. Results The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group ( n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18–7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74–10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47–15.93], transfer from another unit [cOR 6.08, 95% CI:1.95–18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68–47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14–1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002–0.162] were found to be protective factors. Conclusion Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4– to 9–fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.
Intestinal parasitic infections (IPIs) are a public health problem in developing countries such as Sao Tome and Principe (STP) although the pregnancy burden of IPIs is unknown in this endemic country. Thus, the aim of this study was to determine the prevalence of IPIs, prescribed anthelmintics, and associated factors among pregnant women admitted to Hospital Dr. Ayres de Menezes (HAM).
Abstract Background Up to 70% of pregnant women in Africa are reported to have an intestinal parasitic infection (IPI). However, the pregnancy-related burden of adverse birth outcomes (ABOs) remains unclear. Sao Tome & Principe (STP) is an IPI high-endemic country but there is a paucity of data, especially among pregnant women. This study aimed to identify an association between ABOs and IPI in pregnant women. Infection subgroups, such as helminthiasis ( Ascaris lumbricoides , Trichuris trichuria , Ancylostoma duodenale , Strongyloides stercoralis ), schistosomiasis ( Schistosoma intercalatum ) and amebiasis ( Entamoeba histolytica ) were also individually analysed for possible associations with ABOs. Methods A hospital-based cross-sectional study was conducted among pregnant women with coproparasitological antenatal care (ANC) screening admitted to Hospital Dr. Ayres de Menezes for delivery. Pregnant women with HIV, sickle cell disorder, and malaria were excluded for possible confounder causes of ABOs. ANC pregnancy cards were checked for routine coproparasitological results, anthelmintic treatments, and haemoglobin levels. A structured questionnaire was administered by a face-to-face interview to assess sociodemographic and other factors. Newborn clinical records were used for the collection of ABOs: prematurity (PTB), low birth weight (LBW) and stillbirth. The abstracted data were entered into the QuickTapSurvey app and exported to SPSS version 25 for analysis. Pregnant women with a monoparasitic IPI (145) and polyparastic IPI (25) were compared to non-IPI (151) pregnant women for ABOs. IPI subgroups, namely, helminthiasis (162), schistosomiasis (11) and amebiasis (7), were each compared to the non-IPI (151) group. Chi-square and Fisher´s exact tests were used to identify associations between ABOs (maternal anaemia, LBW, PT, and stillbirths) and IPI in pregnant women at p value < 0.05. Results A total of 361 pregnant women with a mean age of 26.96 (SD: 7.00) were included, 127 (39.6%) had maternal anaemia and 26 (8.1%) newborns had PTB, 48 (14.9%) had LBW, and 8 (2.5%) stillbirths. From the 210 positive coproparasitological exams, most had Ascaris lumbricoides (90.9%), followed by Trichuris trichiura (13.8%), Schistosoma intercalatum (5.2%) and Entamoeba histolytica (3.3%). Polyparasitism was found in 25 (11.9%) cases. Anaemia in monoparasitic IPIs (145) was 46.7% compared to 38.7% in noninfected group. Adverse neonatal outcomes in women with monoparasitic IPI were 9 (6.2%) PTB, 16 (11%) LBW and 5 (3.4%) stillbirths, without any statistically significant difference (p = 0.175, p = 0.07, p = 0.275), respectively, when compared with noninfected women. ABOs for polyparasitic IPI compared with non-IPI showed no statistically significant difference. A statistically significant difference was also not found for the subgroups helminthiasis (162), schistosomiasis (11) and amebiasis (7) when compared with non-IPI pregnant women. Conclusion This study highlights the large burden of maternal intestinal parasitic infections in STP. The lack of adverse maternal and neonatal outcomes in our study can be related to the predominant type – Ascaris lumbricoides – a low pathogenicity parasite. This study is a useful starting point for health policy development for pregnant women in a high-IPI endemic country.
Sao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion.A hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P-value < 0.05.A total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3-52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5-56.7). Age 20-34 [AOR 2.27 (95% CI: 1.28-4.04), p = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21-5.20), p = 0.013] when comparing with women aged 14-19 years, urban residence [AOR 1.98 (95% CI: 1.28-3.06), p < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6-4.2), p < 0.001] were the determinants of adequate ANC utilization.Less than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP.
Abstract Background Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents’ characteristics and factors associated to early childbearing in STP. Methods A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers’ clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger ( n =104) were compared to adult mothers ( n =414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p -value ≤0.05. Data were analysed using SPSS software. Results The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2–0.6, p ≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p ≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2–0.7, p =0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2–0.5, p ≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn’s danger signs (OR 15.7, 95% CI= 9–26, p ≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup. Conclusions Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents’ partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns’ danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl’s empowerment and awareness and, at the same time, reinforce boy’s role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn’t, simultaneously, improve educational and economic opportunities for girls.
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