Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.

<h4>Introduction</h4>Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth...

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Autores principales:	Susannah L Woodd, Abdunoor M Kabanywanyi, Andrea M Rehman, Oona M R Campbell, Asila Kagambo, Warda Martiasi, Louise M TinaDay, Alexander M Aiken, Wendy J Graham
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/78998748311f4a23b96007385571c948
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spelling	oai:doaj.org-article:78998748311f4a23b96007385571c9482021-12-02T20:09:42ZPostnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.1932-620310.1371/journal.pone.0254131https://doaj.org/article/78998748311f4a23b96007385571c9482021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254131https://doaj.org/toc/1932-6203<h4>Introduction</h4>Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth in Dar es Salaam.<h4>Methods</h4>We recruited postnatal women from two tertiary hospitals and conducted telephone interviews 7 and 28 days after delivery. Maternal infection (endometritis, caesarean or perineal wound, or urinary tract infection) and newborn infection (umbilical cord or possible severe bacterial infection) were identified using hospital case-notes at the time of birth and self-reported symptoms. Adjusted Cox regression models were used to assess the association between potential risk-factors and infection.<h4>Results</h4>We recruited 879 women and interviewed 791 (90%). From day 0-7, 6.7% (49/791) women and 6.2% (51/762) newborns developed infection. Using full follow-up data, the infection rate was higher in women with caesarean childbirth versus women with a vaginal delivery (aHR 1.93, 95%CI 1.11-3.36). Only 24% of women received pre-operative antibiotic prophylaxis before caesarean section. Infection was higher in newborns resuscitated at birth versus newborns who were not resuscitated (aHR 4.45, 95%CI 2.10-9.44). At interview, 66% (37/56) of women and 88% (72/82) of newborns with possible infection had sought health-facility care.<h4>Conclusions</h4>Telephone surveillance identified a substantial risk of postnatal infection, including cases likely to have been missed by hospital-based data-collection alone. Risk of maternal endometritis and newborn possible severe bacterial infection were consistent with other studies. Caesarean section was the most important risk-factor for maternal infection. Improved implementation of pre-operative antibiotic prophylaxis is urgently required to mitigate this risk.Susannah L WooddAbdunoor M KabanywanyiAndrea M RehmanOona M R CampbellAsila KagamboWarda MartiasiLouise M TinaDayAlexander M AikenWendy J GrahamPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254131 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Susannah L Woodd Abdunoor M Kabanywanyi Andrea M Rehman Oona M R Campbell Asila Kagambo Warda Martiasi Louise M TinaDay Alexander M Aiken Wendy J Graham Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.
description	<h4>Introduction</h4>Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth in Dar es Salaam.<h4>Methods</h4>We recruited postnatal women from two tertiary hospitals and conducted telephone interviews 7 and 28 days after delivery. Maternal infection (endometritis, caesarean or perineal wound, or urinary tract infection) and newborn infection (umbilical cord or possible severe bacterial infection) were identified using hospital case-notes at the time of birth and self-reported symptoms. Adjusted Cox regression models were used to assess the association between potential risk-factors and infection.<h4>Results</h4>We recruited 879 women and interviewed 791 (90%). From day 0-7, 6.7% (49/791) women and 6.2% (51/762) newborns developed infection. Using full follow-up data, the infection rate was higher in women with caesarean childbirth versus women with a vaginal delivery (aHR 1.93, 95%CI 1.11-3.36). Only 24% of women received pre-operative antibiotic prophylaxis before caesarean section. Infection was higher in newborns resuscitated at birth versus newborns who were not resuscitated (aHR 4.45, 95%CI 2.10-9.44). At interview, 66% (37/56) of women and 88% (72/82) of newborns with possible infection had sought health-facility care.<h4>Conclusions</h4>Telephone surveillance identified a substantial risk of postnatal infection, including cases likely to have been missed by hospital-based data-collection alone. Risk of maternal endometritis and newborn possible severe bacterial infection were consistent with other studies. Caesarean section was the most important risk-factor for maternal infection. Improved implementation of pre-operative antibiotic prophylaxis is urgently required to mitigate this risk.
format	article
author	Susannah L Woodd Abdunoor M Kabanywanyi Andrea M Rehman Oona M R Campbell Asila Kagambo Warda Martiasi Louise M TinaDay Alexander M Aiken Wendy J Graham
author_facet	Susannah L Woodd Abdunoor M Kabanywanyi Andrea M Rehman Oona M R Campbell Asila Kagambo Warda Martiasi Louise M TinaDay Alexander M Aiken Wendy J Graham
author_sort	Susannah L Woodd
title	Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.
title_short	Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.
title_full	Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.
title_fullStr	Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.
title_full_unstemmed	Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.
title_sort	postnatal infection surveillance by telephone in dar es salaam, tanzania: an observational cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/78998748311f4a23b96007385571c948
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Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study.

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