First attempt to implement ophthalmia neonatorum prophylaxis in angola: microorganisms, efficacy, and obstacles.

J Carlos Pastor,Mar Justel,Prudencio Martinez,Raul Ortiz De Lejarazu,Isabel Alexandre

doi:10.1155/2015/326526

Abstract

Purpose. To determine the efficacy of povidone-iodine (P-I) prophylaxis for ophthalmia neonatorum (ON) in Angola and to document maternal prevalence and mother-to-child transmission rates. Methods. Endocervical samples from mothers (n = 317) and newborn conjunctival smears (n = 245) were analysed by multiplex polymerase chain reaction (PCR) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG). Newborns were randomized into a noninterventional group and an interventional group that received a drop of P-I 2.5% bilaterally after conjunctival smear collection. Mothers were trained to identify signs of ON and attend a follow-up visit. Results. Forty-two newborns had ocular pathology, and 11 (4.4%) had clinical signs of ON at the time of delivery. Maternal PCR was positive for MG (n = 19), CT (n = 8), and NG (n = 2). Six newborns were positive for CT (n = 4), MG (n = 2), and NG (n = 1). Mother-to-child transmission rates were 50% for CT and NG and 10.5% for MG. Only 16 newborns returned for follow-up. Conclusions. Lack of maternal compliance prevented successful testing of prophylactic P-I efficacy in ON prevention. Nevertheless, we documented the prevalence and mother-to-child transmission rates for CT, NG, and MG. These results emphasize the need to develop an effective Angolan educational and prophylactic ON program.

Highlights

Acute ophthalmia neonatorum (ON) continues to play an important role in causing severe ocular problems of newborns in countries where primary health care coverage is insufficient, as in the case of Angola [1]
Three out of the 11 suspected ON cases were born from mothers with urinary infections during
The nearly complete disappearance of ON in developed countries has been the result of a combination of factors, including prophylactic measures and, above all, better prenatal care [1,2,3, 11, 13]

Summary

Introduction

Acute ophthalmia neonatorum (ON) continues to play an important role in causing severe ocular problems of newborns in countries where primary health care coverage is insufficient, as in the case of Angola [1]. Most of the acute conjunctivitis cases in the newborns are empirically diagnosed as ON and treated without having information on the causative agent. Prenatal screening and treatment of pregnant women are very effective for the prevention of ON [2], this approach can be difficult to implement in developing countries. In some African countries, at the time of delivery, a large percentage of expectant mothers have had little or no prenatal care. Emphasis is placed on maternal surveillance, and there is no systematic prophylaxis of ON

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Conclusion