Background. 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). Methods. A hospital-based cross-sectional study was conducted among pregnant women admitted to the HAM who had undergone antenatal copro-parasitological screening. Data were abstracted from antenatal care (ANC) cards regarding parasitological results and anthelmintic prescriptions. A structured questionnaire face-to-face interview was also applied. Pregnant women with an IPI (210) were compared to noninfected women (151). Data analysis was performed using SPSS version 25.0. Odds ratios (ORs) with 95% confidence intervals (CIs) for factors associated with IPIs were estimated using multiple logistic regression models. A p value <0.05 was considered statistically significant. Results. A total of 361 participants (210 IPI and 151 no-IPI) with a mean age of 26.96 (SD: 7.00) were included. The overall prevalence of IPI was 58.2% (95% CI 52.9 to 63.3), mainly due to helminthiasis, with a 55.9% (95% CI 50.7–61.2%) rate. Ascaris lumbricoides (90.9%) was the most predominant parasite species identified followed by Trichuris trichiura (13.8%). Polyparasitism was observed in 25 cases (11.9%). Anthelmintics were prescribed to 23% of pregnant women. S intercalatum (11) and E histolytica (7) infections were not adequately treated. IPI was significantly associated with primary education (AOR 1.73 (95% CI: 1.10–2.71)), unemployment (AOR 1.94 (95% CI: 1.20–3.13)), and parity of five or above (AOR 3.82 (95% CI: 1.32–11.08)). Conclusion. This study highlights the IPI burden, associated factors, and missing treatment opportunities among pregnant women with STP. This study is a useful tool for policymakers in STP to enhance the health of women and their unborn babies.

Background Adolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP. Methods An institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran’s and Mantel–Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant. Results The adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18–3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07–5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89–12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes. Conclusion Adolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

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.

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.

BackgroundNeonatal 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.MethodsStillbirths 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.ResultsOut 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.ConclusionIn 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: 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 1st trimester (36.4%) and 2nd 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.

Background Neonatal mortality reduction is a global goal but its factors in high-burden nations vary and are poorly understood. This study was conducted to identify the factors affecting peri-neonatal mortality in Sao Tome & Principe (STP), one of the smallest African countries.   Methods Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28 th 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 28 th  day of birth, a phone call was made to evaluate the newborn's health status. A logistic regression model was used to identify the relevant factors associated with mortality, with a level of significance α=0.05.   Results The mean GA 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 mortality. 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 2500 g [cOR 0.017, 95%CI:0.002-0.162] were found to be protective factors. In the multivariable model, meconium-stained fluid was significantly associated with death outcome. Conclusion Of the risk factors associated with peri-neonatal mortality in this study, most can be prevented with continuous monitoring of fetal heart and interventions to reduce perinatal asphyxia. Avoiding health-worker-related factors associated with delays in prompt intrapartum care is a key strategy for STP.

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.