Neonala infection in sub-Saharan Africa: a cross-sectional pilot study on bacterial pathogens and maternal risk factors

by Simone Blumenröder née Grote
Doctoral thesis
Date of Examination:2024-08-20
Date of issue:2024-08-16
Advisor:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Matthias Sigler
Persistent Address: http://dx.doi.org/10.53846/goediss-10675

 

 

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Abstract

English

Despite ongoing efforts to reduce neonatal morbidity and mortality in sub-Saharan Africa, both rates have been remaining alarmingly high. Recognizing the significant impact of neonatal infections, we conducted a pilot study in the lake zone of Western Tanzania. Our objectives were to analyze the incidence of neonatal infections, identify bacterial agents and its antimicrobial resistance patterns, and explore potential maternal risk factors. We evaluated 156 women for potential risk factors and monitored their newborns for signs of infections. The women were interviewed about their medical history and socio-economic status. We identified bacterial pathogens in high vaginal swabs and analyzed neonates‘ cultures if an infection was clinically suspected by using cultures followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) or polymerase-chain-reaction (PCR)-based assays. Antimicrobial resistance was determined using the disc diffusion test and confirmed with the VITEK 2 system. Maternal malaria, blood glucose, and hemoglobin levels were assessed using rapid tests, while helminth infections were detected via stool microscopy. Our study revealed a 22% prevalence of neonatal infections, with 57% of these cases showing culture-positive blood infections. Among early onset infections Gram-negative bacteria resistant to ampicillin were predominant. Late onset infections were mainly caused by Gram-positive bacteria. Almost 30% of all women showed bacterial vaginal colonization besides the normal flora. The predominant vaginal bacterial species among pregnant women was ampicillin resistant E. coli. The low incidence of maternal helminth and Plasmodium infections indicated the effectiveness of national preventive strategies. Maternal urinary tract infections and high blood glucose levels were identified as potential risk factors for early neonatal infections. Elevated blood glucose levels and maternal anemia were linked to late-onset infections. Reducing neonatal mortality, maternal risk factors need to be investigated further. Monitoring maternal urinary tract infections, hemoglobin, and blood glucose levels during pregnacy could help predict and manage neonatal infections. Especially, better knowledge about the vaginal microbiome among African pregnant women could help to implement screening and prevention strategies to reduce neonatal mortality. Given the prevalence of ampicillin-resistant Gram-negative bacteria in neonatal sepsis, it is advisable to consider WHO recommendations for antibiotic treatment in sick neonates.
Keywords: Neonatal infection; Maternal risk factors; Tanzania; Sub-Saharan Africa; Ampicillin; Gram-negative bacteria
 
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