Journal Article > ResearchFull Text
BMC Pregnancy Childbirth. 2020 November 1; DOI:10.21203/rs.3.rs-62820/v1
Schuurmans J, Borgundvaag E, Finaldi P, Senat-Delva R, Desauguste F, et al.
BMC Pregnancy Childbirth. 2020 November 1; DOI:10.21203/rs.3.rs-62820/v1
The prevalence of (pre-)eclampsia in pregnant women in Haiti is high and access to maternal health services is scarce. Limited evidence exists around negative maternal and neonatal outcomes in Haitian women and their offspring. We describe the patient profile of women admitted to an obstetric emergency hospital in Port-au-Prince between January 2013 and June 2018 and the estimated risk factors for maternal death, stillbirth and low birthweight (LBW).
Methods
We calculated frequencies of age groups, singleton vs. multiple pregnancies, delivery procedures and antenatal care (ANC) services for all maternal admissions. We estimated the associated risk between these factors and the three negative outcomes by calculating odds ratios (OR) and their 95% confidence intervals (CI) using univariate and multivariate logistic regression. We adjusted for an interaction between delivery procedure and pregnancy category in the regression models for maternal death and stillbirth.
Results
We included 31,509 women and 24,983 deliveries and documented 204 (0.6%) maternal deaths (648/100,000 women giving birth), 1,962 (7.9%) stillbirths and 11,008 (44.1%) LBW neonates. 34.9% of all admissions (n = 10,991) were women with (pre-)eclampsia. Maternal death was more likely in women with complicated pregnancies and/or deliveries and women with (pre-)eclampsia when undergoing a C-section compared to women with uncomplicated vaginal deliveries (OR 4.8; CI 1.7–13.8 and OR 2.3; CI 1.5–3.6 respectively). Stillbirth was more likely in women ≥ 35 years compared to women 20–34 years in complicated pregnancies and/or deliveries (OR 1.3; CI 1.1–1.6) and (pre-)eclampsia (OR 1.4; CI 1.2–1.7). C-sections in women with a complicated pregnancy and/or delivery and women with (pre-)eclampsia reduced the risk of stillbirth (OR 0.7; CI 0.6–0.9 and OR 0.3; CI 0.2–0.3 respectively). Not attending ANC was associated with a higher risk of stillbirth (OR 4.8; CI 3.6–6.6) and LBW (OR 1.4; CI 1.1–1.9) for women with complicated pregnancies and/or deliveries.
Conclusion
Maternal mortality in high-risk pregnancies in CRUO is higher than the national estimate of 529 per 100,000 deliveries. Attendance of ANC services is associated with a decrease in adverse neonatal outcomes including LBW and stillbirth. We recommend that access to maternal and neonatal healthcare facilities in Port-au-Prince is improved.
Journal Article > ResearchFull Text
Rev Panam Salud Publica. 2021 November 1; Volume 45; e147.; DOI:10.26633/RPSP.2021.147
Schuurmans J, Borgundvaag E, Finaldi P, Senat-Delva R, Desauguste F, et al.
Rev Panam Salud Publica. 2021 November 1; Volume 45; e147.; DOI:10.26633/RPSP.2021.147
OBJECTIVES
To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes.
METHODS
We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services.
RESULTS
A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55-6.55) and low birthweight (OR 1.40; 95% CI 1.05-1.86) for women with complicated pregnancies.
CONCLUSION
To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.
To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes.
METHODS
We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services.
RESULTS
A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55-6.55) and low birthweight (OR 1.40; 95% CI 1.05-1.86) for women with complicated pregnancies.
CONCLUSION
To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.
Protocol > Research Study
Verputten M, Siddiqui R, Gray NSB, Casimir CF, Finaldi P, et al.
2018 July 1
2 Research question and objectives
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
Conference Material > Poster
Himanshu M, Lin Oo W, Cavalheiro AP, Mesic A, Shougrakpam J, et al.
MSF Scientific Days International 2020: Research. 2020 May 20
Conference Material > Poster
Himanshu M, Lin Oo W, Cavalheiro AP, Mesic A, Shougrakpam J, et al.
MSF Scientific Days International 2020: Research. 2020 May 20
Journal Article > ResearchFull Text
J Glob Antimicrob Resist. 2020 December 1; Volume 23; 102-107.; DOI:10.1016/j.jgar.2020.08.017
Lenglet AD, Schuurmans J, Ariti C, Borgundvaag E, Charles K, et al.
J Glob Antimicrob Resist. 2020 December 1; Volume 23; 102-107.; DOI:10.1016/j.jgar.2020.08.017
OBJECTIVES
We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti.
METHODS
We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis.
RESULTS
We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%.
CONCLUSIONS
The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.
We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti.
METHODS
We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis.
RESULTS
We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%.
CONCLUSIONS
The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.