Browsing by Author "Mohammed, Musa"

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    Group B Streptococci: Colonization Rate Among Pregnant Women and Their Newborn and Burden of Neonatal Disease in Selected Hospitals of Ethiopia
    (Addis Ababa Universty, 2018-03) Mohammed, Musa; Woldeamanuel, Yimtubezenash (MD, M. Sc, PhD)
    Background: The newborn of today have a good chance of survival compared to several years back. The number of worldwide child deaths has decreased, from 12.7 million in 1990 to 5.9 million in 2015. Neonatal mortality reduction is still far behind MDG4 particularly in sub Saharan Africa, including Ethiopia. About 44% of world-wide mortality in children less than five years occurs in the first month of life. Several microorganisms are involved in neonatal ill health; among them Group B streptococcus (GBS), was identified relatively recently as the leading cause of neonatal disease in developed countries. Group B streptococcus is transmitted from colonized mother to newborn during birth. The primary risk factor for development of Early Onset Diseade due to GBS (EOD-GBS) is maternal colonization with GBS during late trimester. Objective: The objectives of this study were to determine GBS colonization rate among pregnant women and their new born who were attending selected hospitals, vertical transmission rate, burden of neonatal disease due to GBS and phenotypic and genotypic characterization of GBS. Materials and Methods: A cross-sectional and follow-up study was conducted in three different Hospitals starting from June 2014 to August 2015: Adama Hospital Medical College (AHMC), Hawassa Referral Hospital (HRH), and Tikur Anbessa Specialized Hospital (TASH). A total of 1873 participants were recruited in the present study. Among them, 840 of them were pregnant women and 857 of them were their new born from three study sites. All of them were screened for GBS using standard methods recommended by Center of Disease Control and Prevention (CDC). Out of the total study participants, 176 of them were infants suspected of early and late onset disease whose age was less than 90 months from Tikur Anbesa Specialized Hospital. Their blood and CSF were cultured to isolates GBS. The isolated GBS were serotyped by using serotype specific antisera. Selected GBS isolates were further characterized by multiplex PCR, antimicrobial susceptibility pattern and Multilocus Sequence typing. Structured questionnaire was used to collect Sociodemographic and clinical data of pregnant mother and newborn. Data was analyzed using SPSS version 20; P value <0.05 was considered statistically significant. XVII Result: The overall maternal, Newborn GBS colonization and vertical transmission rate were 17.4%, 9.2% and 54.1% respectively. The overall prevalent serotypes detected in the present study include; type II (30.3%), Ia (20.2%), V (17.9%), Ib (17.1%), III (10.1%), VII (0.9%), and non typeable (3.5%). The burden of neonatal disease due to GBS was 1.7%. No significant association between maternal and newborn GBS colonization rate and measured risk factors was found (P>0.05). All GBS isolates tested were sensitive to Penicillin, Vancomycin, Cefotaxime and Linezolid. Most of the GBS isolates were resistant to Tetracycline (91.2%), majority of them were sensitive to Levofloxacin (92.8%), Daptomycin (97.6%), Erythromycin (91.2%) and Clindamycin (98.4%). Among 123 GBS tested 89.4% of them contain antibiotic resistance genes. The antibiotic resistance genes detected include; tet (M-1) (88.6%), tet (L-1) (31.7%), erm (TR-1) (5.7%), gyra (GBS-1) (4.1%), par C (GBS-1) (4.1%), erm (B-1) (0.8%), and tet (O-1) (0.8%). MLST characterization grouped all GBS strains in to 17 STs, two clonal complexes (CC-2 and CC- 249) and one singleton. ST-10, ST-19 and ST-23 are the most prevalent STs found in the study. ST-932, ST-933, ST-934, ST-935, and ST-936 were new sequence types that have been identified in this study. Conclusion: This multi center study reveals the presence of primary risk factor, maternal GBS colonization, for early onset neonatal disease due to GBS in three Referral Hospitals of Ethiopia. The study also showed significant importance of invasive neonatal disease due to GBS from selected Hospital of Ethiopia for the first time. Epidemiology of GBS serotypes, antibiotic resistance pattern, MLST profile, and population structure of GBS collection from Ethiopia is partially different from other parts of the world. Therefore, it is important to measure neonatal disease due to GBS at large scale and consider prevention strategy such as Intrapartum prophylaxis and vaccine.
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    Prevalence of Group B Streptococcus Colonization Among Pregnant Women Attending Antenatalclinic of Hawassa Health Center, Hawassa, Ethiopia
    (Addis Ababa University, 2008) Mohammed, Musa; Asrat, Daniel(PhD)
    Background: Group B streptococcus (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. During labor GBS may infect the newborn, leading to neonatal sepsis and meningitis. GBS emerged in the 1970s as one of the most frequent causes of sepsis and meningitis in neonates and young infants. Since the mid-1960s, GBS has become the major cause of bacterial infections in the perinatal period, including bacteraemia, amnionitis, endometritis, and urinary tract infection in pregnant women. Rates of GBS colonization vary widely throughout the world due to differences in laboratory investigation methods, regional variations and racial differences. Report on prevalence of GBS among pregnant women in Ethiopia is very limited. Objectives: The objective of this study was to determine the prevalence of group B Streptococcal (GBS) colonization among pregnant women attending antenatal clinic at Hawassa Health centre, Hawassa Ethiopia and analyze risk factors related to GBS colonization. Methods: A total of 139 pregnant women were screened for GBS colonization between May and June 2010. Standard microbiological methods were used to isolate and identify GBS from vaginal and anorectal swabs obtained from study subjects. Antimicrobial susceptibility test was performed for all GBS isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Results: A total of 29 out of 139 pregnant women studied (20.8%) were colonized by GBS. No statistically significant association was observed for GBS colonization with any of sociodemographic characteristics of the study subjects including age, occupation, type of contraceptive used, types of gravida, number of antenatal clinic visits etc. All GBS strains were susceptible to penicillin, ampicillin, vancomycin and gentamicin, Low level of resistance (<60%) were observed against erythromycin, tetracycline, ceftriaxone, chloramphenicol, ciprofloxacin and norfloxacin. Conclusion and recommendations: this study including 139 pregnant women, confirmed the prevalence of GBS colonization to be around 21%. This prevalence was compared with findings reported from developed and developing countries and have reached comparable level. However, further epidemiological investigations should be conducted in different parts of the country in order to know the actual GBS colonization rate in pregnant women and consider implementation of prevention plans using intrapartum antibiotics prophylaxis to prevent early onset GBS-neonatal diseases. Key words: Group B Streptococcus (GBS), risk factors, Antibiotic susceptibility, Ethiopia.