Maternal group B Streptococcus recto vaginal colonization increases the odds of stillbirth: evidence from Eastern Ethiopia

Tesfaye Assebe Yadeta,Dadi Marami,Yemane Berhane,Gudina Egata,Berhanu Seyoum,Alemayehu Worku

doi:10.1186/s12884-018-2044-2

Tesfaye Assebe Yadeta, Dadi Marami + Show 4 more

Open Access

https://doi.org/10.1186/s12884-018-2044-2

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Abstract

BackgroundGroup B Streptococcus (GBS) causes a significant number of stillbirths. Despite this, there is little documented information on the association between stillbirth and pregnant women’s GBS recto vaginal colonization in Sub Saharan Africa. As such, this study was aimed at identifying the association between stillbirth and pregnant women’s GBS recto vaginal colonization in Eastern Ethiopia.MethodsA health facility-based cross-sectional study was conducted among 1688 pregnant women who came for delivery service in Harar town, Eastern Ethiopia between June to October in 2016. Data were collected using a pre-tested structured questionnaire and checklist (which utilize clinical record). Group B streptococcus positivity of the pregnant women was confirmed by culture of recto vaginal swab using selective media. The association between GBS colonization and stillbirth was examined using multivariable logistic regression analysis. A statistical significance was declared at p-value ≤0.05.ResultsOf the 1688 pregnant women who participated in the study, 144 had stillbirths, representing a prevalence of 8.53% [(95% CI: (7.19, 9.86)]. Group B Streptococcus colonization at birth was detected in 231 women (13.68%; 95% CI 12.04, 15.32). Of these 144 stillbirths 59 (40.97%) were from colonized mothers and 72(59.03%) were from non-colonized mothers. Of these 59 stillbirth from colonized mothers, 32(54.23%) were intrapartum stillbirth, 27(45.77%) were antepartum stillbirth occur before exposed to intrapartum antibiotic prophylaxis (IAP). After controlling for potential confounders, the odds of having a stillbirth were 8.93 times higher among recto vaginal GBS colonized pregnant women [AOR = 8.93; 95% CI; (5.47, 14.56)].ConclusionsThis study demonstrated a significant association between maternal recto vaginal GBS colonization and stillbirth. Efforts to reduce stillbirth need to consider prevention of GBS colonization among pregnant women. Maternal vaccination may provide a feasible strategy to reduce stillbirth due to GBS.

Highlights

Group B Streptococcus (GBS) causes a significant number of stillbirths
Study setting This study was performed in three health facilities (Hiwot Fana Specialized University Hospital, Jugal Hospital and Arategna Health Center) in Harar town, Eastern Ethiopia
Ethiopia is a low-income country with a total fertility rate of 4.6 per woman [15], stillbirth rates of 25.5 per 1000 birth [11], a neonatal mortality rate of 29 per 1000 live births [15] and 34.3% of neonatal deaths are due to infection [16]

Summary

Introduction

There is little documented information on the association between stillbirth and pregnant women’s GBS recto vaginal colonization in Sub Saharan Africa. This study was aimed at identifying the association between stillbirth and pregnant women’s GBS recto vaginal colonization in Eastern Ethiopia. Of the estimated 2·6 million stillbirths that occur globally every year, 98% occur in low-income and middle-income countries [1]. Sub-Saharan Africa harbors the highest stillbirth rates with Ethiopia ranking fifth among the ten countries with the highest stillbirth rates in the world [1, 2]. Stillbirth is a major cause of psychosocial distress, grief and guilt to families [3]. In Sub Saharan Africa, mothers who have stillbirth are often subjected to severe psychosocial pressure; especially women who experience repeated stillbirth, can be out casted, dishonored and subjected to divorce [4, 5]

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