Knowledge gaps among South African healthcare providers regarding the prevention of neonatal group B streptococcal disease

Price, C; Green-Thompson, Lionel; Mammen, Vijay; Madhi, Shabir А.; Lala, Sanjay G.; Dangor, Ziyaad

doi:10.1371/journal.pone.0205157

Cited by 3 publications

(12 citation statements)

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“…Intrapartum antibiotic prophylaxis (IAP) has been shown to significantly reduce the incidence of Early Onset GBS disease worldwide (32) and while risk factor based IAP policies are in place at a National level in South Africa, implementation and coverage are as low as 26% (33). These findings further emphasise the need for GBS preventative strategies, including possibly maternal immunization with a GBS vaccine that could reduce the risk of in-utero GBS infection that may drive the pathogenesis of neonatal encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

The association between early-onset sepsis and neonatal encephalopathy

et al. 2022

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Objective: We evaluated the association between early-onset sepsis and neonatal encephalopathy in a low-middle-income setting. Methods:We undertook a retrospective study in newborns with gestational age ≥35 weeks and/or birth weight ≥2 500 grams, diagnosed with neonatal encephalopathy. Early-onset sepsis was defined as culture-confirmed sepsis or probable sepsis.Results: Of 10 182 hospitalized newborns, 1 027 (10.1%) were diagnosed with neonatal encephalopathy, of whom 52 (5.1%) had culture-confirmed and 129 (12.5%) probable sepsis. The case fatality rate for culture-confirmed sepsis associated neonatal encephalopathy was 3fold higher compared to neonatal encephalopathy without sepsis (30.8% vs. 10.5%, p<0.001). Predictors of mortality for culture-confirmed sepsis associated neonatal encephalopathy included severe neonatal encephalopathy (aOR 6.51, 95%CI: 1.03-41.44) and seizures (aOR 10.64, 95%CI: 1.05-107.39). Conclusion:In this setting, 5% of neonatal encephalopathy cases was associated with culture-confirmed sepsis and a high case fatality rate.

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Section: Discussionmentioning

confidence: 99%

The association between early-onset sepsis and neonatal encephalopathy

et al. 2022

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“…Most studies explored the perspectives and experiences of health providers [ 20 , 37 – 53 ], while 3 studies included relevant data from the perspectives of women [ 19 , 54 , 55 ]. Included studies were published between 1990 and 2020, and were conducted in 11 countries: Canada [ 43 ], Denmark [ 54 ], France [ 48 ], Ghana [ 49 ], Israel [ 41 ], Netherlands [ 42 ], Nigeria [ 38 ], and South Africa [ 46 ]; Thailand [ 20 , 44 ], United Kingdom [ 19 , 37 , 45 , 50 ], and United States of America (USA) [ 39 , 40 , 47 , 51 , 52 ]. All but 4 studies [ 20 , 38 , 44 , 46 , 49 ] were conducted in high-income countries.…”

Section: Resultsmentioning

confidence: 99%

“…Included studies were published between 1990 and 2020, and were conducted in 11 countries: Canada [ 43 ], Denmark [ 54 ], France [ 48 ], Ghana [ 49 ], Israel [ 41 ], Netherlands [ 42 ], Nigeria [ 38 ], and South Africa [ 46 ]; Thailand [ 20 , 44 ], United Kingdom [ 19 , 37 , 45 , 50 ], and United States of America (USA) [ 39 , 40 , 47 , 51 , 52 ]. All but 4 studies [ 20 , 38 , 44 , 46 , 49 ] were conducted in high-income countries.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 5 qualitative, 12 quantitative and 2 mixed-methods studies were included (Table 1). Sixteen studies considered the use of prophylactic antibiotics (3 qualitative, 2 mixed methods, and 11 quantitative) [20,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] and 2 considered the use of antiseptics (1 qualitative, 1 quantitative), and 1 considered the use of antibiotics and antiseptics (1 quantitative). Findings are reported separately for each intervention.…”

Section: Resultsmentioning

confidence: 99%

“…Minor differences, however, were observed. For example, lack of infection control training and knowledge were commonly reported in studies in low- and middle-income countries [ 38 , 46 ], which might reflect broader or more systemic challenges to delivering maternity services [ 62 ]. Provider decisions around antibiotic prophylaxis use were also influenced by the view of senior colleagues such as supervisors [ 20 , 38 ], suggesting that mentoring or engaging local champions from a senior staff level may be effective strategies to improve appropriate antibiotic use [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

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Factors affecting the use of antibiotics and antiseptics to prevent maternal infection at birth: A global mixed-methods systematic review

et al. 2022

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Background Over 10% of maternal deaths annually are due to sepsis. Prophylactic antibiotics and antiseptic agents are critical interventions to prevent maternal peripartum infections. We conducted a mixed-method systematic review to better understand factors affecting the use of prophylactic antibiotics and antiseptic agents to prevent peripartum infections. Methods We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health, Global Index Medicus, and Maternity and Infant Care for studies published between 1 January 1990 and 27 May 2022. We included primary qualitative, quantitative, and mixed-methods studies that focused on women, families, and healthcare providers’ perceptions and experiences of prophylactic antibiotic and antiseptics during labour and birth in health facilities. There were no language restrictions. We used a thematic synthesis approach for qualitative evidence and GRADE-CERQual approach for assessing confidence in these review findings. Quantitative study results were mapped to the qualitative findings and reported narratively. Results We included 19 studies (5 qualitative, 12 quantitative and 2 mixed-methods studies), 16 relating to antibiotics, 2 to antiseptic use, and 1 study to both antibiotic and antiseptic use. Most related to providers’ perspectives and were conducted in high-income countries. Key themes on factors affecting antibiotic use were providers’ beliefs about benefits and harms, perceptions of women’s risk of infection, regimen preferences and clinical decision-making processes. Studies on antiseptic use explored women’s perceptions of vaginal cleansing, and provider’s beliefs about benefits and the usefulness of guidelines. Conclusion We identified a range of factors affecting how providers use prophylactic antibiotics at birth, which can undermine implementation of clinical guidelines. There were insufficient data for low-resource settings, women’s perspectives, and regarding use of antiseptics, highlighting the need for further research in these areas. Implications for practice include that interventions to improve prophylactic antibiotic use should take account of local environments and perceived infection risk and ensure contextually relevant guidance.

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Acceptability and feasibility of maternal screening for Group B Streptococcus: a rapid review

Constantinou,

Webb,

Ayers

et al. 2024

Preprint

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BackgroundThe risks and benefits of maternal screening for GBS during pregnancy or the intrapartum period are widely debated, since screen positive results trigger prophylactic antibiotic use. There is little known about women’s and health professional’s views regarding GBS screening.ObjectivesTo conduct a rapid review to synthesise evidence on women and health professionals’: (1) knowledge and awareness of; (2) preferences for; and (3) acceptability of GBS screening programmes, and (4) how feasible they are to implement.MethodLiterature searches were conducted using online databases from their inception to 2023. Papers were included if they reported primary research from the perspectives of health professionals and women, about their knowledge and awareness, preferences, acceptability and feasibility of different types of GBS screening programmes. Data were assessed for confidence using GRADE- CERQual and analysed using a convergent synthesis approach.Findings42 papers were eligible for inclusion. A total of 16,306 women and professionals were included. Women generally did not have extensive knowledge about GBS. Health professionals had a higher level of knowledge than women. Women were generally (but not universally) positive about GBS testing procedures. Some women were concerned about the impact on their place of birth.Discussion and ConclusionWhere GBS screening programmes are available, parents must be provided with high quality information about them. Health professionals and service managers need to weigh up the benefits and risks of screening for GBS with local feasibility and treatment options, and with women’s individual values and birth plans.Statement of significanceProblem:Maternal GBS colonisation at birth can lead to invasive GBS disease. The risks and benefits of screening for GBS during pregnancy is widely debated.What is already known:Different countries use different GBS screening strategies, such as the universal screening strategy vs risk based.What this paper adds:The World Health Organization reviewed their GBS policy guidelines in 2024.Resultsfrom this paper were used to ensure women and health professional’s views were considered. This paper found that women are generally (but not universally) positive about GBS testing procedures with some concerned about the impact on their birth choices.

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Knowledge gaps among South African healthcare providers regarding the prevention of neonatal group B streptococcal disease

Cited by 3 publications

References 20 publications

The association between early-onset sepsis and neonatal encephalopathy

The association between early-onset sepsis and neonatal encephalopathy

Factors affecting the use of antibiotics and antiseptics to prevent maternal infection at birth: A global mixed-methods systematic review

Acceptability and feasibility of maternal screening for Group B Streptococcus: a rapid review

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