Intestinal Parasitic Infections, Treatment and Associated Factors among Pregnant Women in Sao Tome and Principe: A Cross-Sectional Study

PLOS Glob Public Health

et al. 2022

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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.

Section: Introductionmentioning

confidence: 99%

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

PLOS Glob Public Health

et al. 2022

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“…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.…”

Section: Study Population and Samplingmentioning

confidence: 99%

“…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]. In the present study, we sought to identify whether there were adverse obstetric and perinatal outcomes associated with these pregnancies.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

Preprint

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Background Up to 70% pregnant women in Africa have an intestinal parasitic infection (IPI), but their adverse birth outcomes (ABOs) remain unclear. Sao Tome & Principe (STP) is an IPI high-endemic country but there is a paucity of data. This study aimed to identify an association between ABOs -maternal anaemia, prematurity (PTB), low-birth-weight (LBW) and stillbirths- and IPI in pregnant women. Methods A hospital-based cross-sectional study was conducted among pregnant women admitted for delivery. ANC pregnancy cards were checked for coproparasitological results, treatments, and haemoglobin levels. A structured questionnaire was administered to assess sociodemographic factors. Newborn records were used for ABOs. Pregnant with a monoparasitic-IPI (n=145) and polyparastic-IPI (n=25) were compared to noninfected-group (n=151) for ABOs. IPI-subgroups: helminthiasis (n=162), schistosomiasis (n=11) and amebiasis (n=7), were each compared to the noninfected-group. 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 pregnant women with a mean age of 26.96 (SD: 7.00) were included. From the 210 positive coproparasitological exams, 90.9% had Ascaris lumbricoides, followed by 13.8% Trichuris trichiura, 5.2% Schistosoma intercalatum and 3.3.% Entamoeba histolytica. Anaemia in monoparasitic-IPIs (145) was 46.7% compared to 38.7% in noninfected-group. ABOs in monoparasitic-IPI-women were 6.2% PTB, 11% LBW and 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 noninfected-group also showed no statistically significant difference. A statistically significant difference was also not found for the subgroup’s helminthiasis, schistosomiasis and amebiasis when compared with noninfected pregnant women. Conclusion The lack of ABOs 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.

“…Routine copro-parasitological screening for parasitic infections is requested during ANC services, with costs for pregnant women. The copro-parasitological tests performed in STP consist of stool sampling using the direct wet mount and formol-ether concentration method [43,45]. The exam is declared positive when stages of the parasites, such as trophozoites, cysts, ova, and larvae, are observed by trained parasitologists, con rmed by a senior one.…”

Section: Settingmentioning

confidence: 99%

“…Pregnant women bring the ANC pregnancy card to each contact and to the maternity unit at the baby´s delivery. The IPI prevalence among pregnant women, characterization of ANC copro-parasitological test results and species found, anthelmintics prescribed for IPIs among pregnant women during ANC and factors associated with IPIs in pregnancy were already analysed and reported in another article [43].…”

Section: Settingmentioning

confidence: 99%

Intestinal parasitic infections and adverse outcomes for pregnant women and their newborns in Sao Tome & Principe: a hospital-based cross-sectional study

et al. 2023

Preprint

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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, p0.175, 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.