Antenatal screenings and maternal diagnosis among pregnant women in Sao Tome & Principe—Missed opportunities to improve neonatal health: A hospital-based study

Abstract

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.

Sickle cell trait in São Tomé e Príncipe: a population-based prevalence study in women of reproductive age

“…Thus, we expect that this value corresponds to the estimated prevalence of SCT in the whole population between 15 and 49 years in São Tomé e Príncipe. This prevalence is accordant to the previous studies in the country [ 13 – 15 ]. Ranking high in the interval of prevalence found in West Africa [ 2 ], this highlights the need for São Tomé e Príncipe to participate in the regional effort to tackle the disease [ 12 ].…”

“…São Tomé e Príncipe, the archipelagic country in the Gulf of Guinea, still lacks official numbers on carriers and patients. Three previous hospital-based studies point to an SCT prevalence between 13.00% [ 13 ], 14.10% (plus 1.92% of Hemoglobin C) [ 14 ] and 19.40% [ 15 ]. A revision of the 2021 Global Burden of Disease estimated that SCD was the 5th cause of under-five mortality in the country [ 16 ].…”

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

“…The study also discovered that young mothers (those under the age of 30) were 40% less likely to use ANC services than older mothers. This supported the findings of Vasconcelos et al [45]. In Bangladesh, women's age was found to have a significant influence on their use of ANC.…”

Intestinal parasitic infections in pregnant women in Sao Tome & Principe: are there adverse birth outcomes?

“…The sample size for the original study followed the WHO-steps approach [34][35][36][37]39], applying a webbased sample size calculator, Raosoft (http://www.raosoft.com/samplesize.html), which suggested a minimum sample size of S = 355, which placed the right dimension between 355 (95%) and 579 (99%) con dence. A total of 518 participants were enrolled for the original study based on the following assumptions: two-sided 95% con dence level, power of 80% to detect an odds ratio of at least 2 for adverse birth outcomes.…”

“…To notice that this study was undertaken within the context of a broader project on the causes and associated factors contributing to neonatal mortality and adverse birth outcomes in STP [34][35][36]. The authors have previously studied intestinal parasitic infection prevalence, anthelmintic treatments and associated factors among these pregnant women [37].…”