scholarly journals Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Stitterich ◽  
J. Shepherd ◽  
M. M. Koroma ◽  
S. Theuring
Keyword(s):  
Risk Factors ◽  
Sierra Leone ◽  
Case Control Study ◽  
Care Facility ◽  
Maternity Hospital ◽  
Case Control ◽  
Postpartum Women ◽  
Close Monitoring ◽  
Maternal Deaths ◽  
Control Study

Abstract Background In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. Methods A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing ‘Comprehensive Emergency Obstetric and Neonatal Care services’ throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women’s health. Statistical analysis was performed by estimating a binary logistic regression model. Results We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46–5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32–10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83–5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28–3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63–4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63–4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64–4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31–3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15–3.25). Conclusion Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.

scholarly journals Maternal caesarean section infection (MACSI) in Sierra Leone: a case–control study

2020 ◽  
Vol 148 ◽  
Author(s):  
F. Di Gennaro ◽  
C. Marotta ◽  
L. Pisani ◽  
N. Veronese ◽  
V. Pisani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Sierra Leone ◽  
Case Control Study ◽  
Multivariable Analysis ◽  
Maternity Hospital ◽  
Case Control ◽  
Maternal Deaths ◽  
Low Education ◽  
Control Study

Abstract Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case–control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36–1.66), low education level (OR 1.68, 95% CI 1.55–1.84), previous CS (OR 1.27, 95% CI 1.10–1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18–1.88), a long decision–incision time (OR 2.08, 95% CI 1.74–2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10–2.85).

scholarly journals Risk factors for postpartum sepsis: A nested case control study

2020 ◽  
Author(s):  
Samina Bakhtawar ◽  
Sana Sheikh ◽  
Rahat Qureshi ◽  
Zahra Hoodbhoy ◽  
Beth Payne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Sign ◽  
Case Control Study ◽  
Multivariable Analysis ◽  
Clinical Signs ◽  
Case Control ◽  
Postpartum Women ◽  
Discriminative Performance ◽  
Maternal Deaths ◽  
Control Study

Abstract Background: Majority (99%) of maternal deaths occur in low and middle income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criterion is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations which may not be feasible in resource constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.Methods: A case control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted in study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to socio-demographic status, antenatal care and maternal life styles were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC).Results: Multivariable analysis revealed that 1-4 antenatal visits (95% CI 0.01 - 0.62), 3 or more vaginal examinations (95% CI 1.21 - 3.65), home delivery (95% CI 1.72-50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93-20.23), lower abdominal pain (95% CI 1.15 - 3.42)) vaginal discharge (95% CI 2.97-20.21), SpO2 <93% (95% CI 4.80-37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80-0.89) which indicated that risk factors and clinical sign and symptoms based model has adequate ability to discriminate women with and without sepsis.Conclusion: This study developed a non-invasive tool which can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has a potential to be scaled up for community use by frontline health care workers.

scholarly journals Risk factors for postpartum sepsis: A nested case-control study

2020 ◽  
Author(s):  
Samina Bakhtawar ◽  
Sana Sheikh ◽  
Rahat Qureshi ◽  
Zahra Hoodbhoy ◽  
Beth Payne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Sign ◽  
Case Control Study ◽  
Multivariable Analysis ◽  
Clinical Signs ◽  
Case Control ◽  
Postpartum Women ◽  
Discriminative Performance ◽  
Maternal Deaths ◽  
Control Study

Abstract Background: The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women. Methods: A case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC). Results: Multivariable analysis revealed that 1-4 antenatal visits (95% CI 0.01 - 0.62) , 3 or more vaginal examinations (95% CI 1.21 - 3.65), home delivery (95% CI 1.72-50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93-20.23), lower abdominal pain (95% CI 1.15 - 3.42)) vaginal discharge (95% CI 2.97-20.21), SpO2 <93% (95% CI 4.80-37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80-0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis. Conclusion: This study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.

scholarly journals Determinants of maternal deaths amongst mothers who suffered from post-partum haemorrhage: a community-based case control study

2018 ◽  
Vol 5 (7) ◽  
pp. 2814
Author(s):  
Divya Khanna ◽  
Jai Veer Singh ◽  
Monika Agarwal ◽  
Vishwajeet Kumar
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Bivariate Analysis ◽  
Paired Data ◽  
Community Based ◽  
Maternal Deaths ◽  
Control Study

Background: The WHO estimates that, of the 529 000 maternal deaths occurring every year 136 000 take place in India amongst which postpartum haemorrhage (PPH) being the most (29.6%) commonly reported complication. However deaths from PPH can be prevented. The purpose of this study was to identify the risk factors contributing to maternal deaths amongst women who develop PPH.Methods: This was a community based paired case-control study done in rural areas of Lucknow, UP (India) done in a period of one year. Thirty-one maternal deaths due to PPH (cases) were matched and compared with two mothers who survived from PPH (controls). Data was analysed using SPSS version 17.0 and Open Epi version 2.3. The appropriate significance test was applied using MacNemar test for paired data. Risk factors obtained significant in bivariate analysis were subjected to conditional multiple logistic regressions for adjustment and controlling the effect of confounding variables. Results have been given in form of unadjusted Odds ratio (UOR) and adjusted Odds ratio (AOR).Results: It was seen that the mothers who had taken ≥4 antenatal visits during the index pregnancy had a protective effect against deaths due to PPH. Home delivery raised the odds of death by seven times.Conclusions: Deaths due to PPH can be reduced by ensuring institutional delivery, good antenatal care and better referral facilities, especially for mothers from weaker sections of society.

Chloramphenicol Resistance in Vancomycin-Resistant Enterococcal Bacteremia: Impact of Prior Fluoroquinolone Use?

2004 ◽  
Vol 25 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Carolyn V. Gould ◽  
Neil O. Fishman ◽  
Irving Nachamkin ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Control ◽  
Close Monitoring ◽  
Chi Square ◽  
Chloramphenicol Resistance ◽  
Vancomycin Resistant ◽  
Control Study

AbstractObjective:The prevalence of vancomycin-resistant enterococci (VRE) has increased markedly during the past decade. Few data exist regarding the epidemiology of resistance of VRE to chloramphenicol, one of the few therapeutic options.Design:Survey and case-control study.Setting:A 725-bed, tertiary-care academie medical center and a 344-bed urban community hospital.Patients:Hospitalized patients with blood cultures demonstrating VRE.Methods:We examined the trends in the prevalence of chloramphenicol resistance in VRE blood isolates at our institution from 1991 through 2002 and conducted a case-control study to identify risk factors for chloramphenicol resistance among these isolates.Results:From 1991 through 2002, the annual prevalence of chloramphenicol-resistant VRE increased from 0% to 12% (P < .001, chi-square test for trend). Twenty-two case-patients with chloramphenicol-resistant VRE bloodstream isolates were compared with 79 randomly selected control-patients with chloramphenicol-susceptible VRE. Independent risk factors for chloramphenicol-resistant VRE were prior chloramphenicol use (odds ratio [OR], 10.9; 95% confidence interval [CI95], 1.72-68.91; P = .01) and prior fluoroquinolone use (OR, 4.74; CI95, 1.15-19.42; P = .03). Chloramphenicol-resistant VRE isolates were more likely to be susceptible to beta-lactams and resistant to tetracycline than were chloramphenicol-susceptible VRE isolates.Conclusions:Significant increases in the prevalence of chloramphenicol-resistant VRE may limit the future utility of chloramphenicol in the treatment of VRE infections, and close monitoring of susceptibility trends should continue. The association between fluoroquinolone use and chloramphenicol-resistant VRE, reflecting possible co-selection of resistance, suggests that recent dramatic increases in fluoroquinolone use may have broader implications than previously recognized.

scholarly journals Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Alice Y Guh ◽  
Susan Hocevar Adkins ◽  
Qunna Li ◽  
Sandra N Bulens ◽  
Monica M Farley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Clostridium Difficile ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Care Facility ◽  
The United States ◽  
Case Control ◽  
Beta Lactam ◽  
Control Study

Abstract Background An increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors. Methods We enrolled participants from 10 US sites during October 2014–March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed. Results Of 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P &lt; .0001) and antibiotic (62.2% vs 10.3%; P &lt; .0001) exposures. In multivariate analysis, antibiotic exposure—that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13–321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01–311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77–340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76–340.05),—emergency department visit (AmOR, 17.37; 95% CI, 1.99–151.22), white race (AmOR 7.67; 95% CI, 2.34–25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20–19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24–118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27–20.79) were associated with CA-CDI. Conclusions Antibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.

scholarly journals Risk factors for episiotomy: a case-control study

2014 ◽  
Vol 60 (5) ◽  
pp. 465-472 ◽  
Author(s):  
Giordana Campos Braga ◽  
Suelem Taís Pereira Clementino ◽  
Patrícia Ferreira Neves da Luz ◽  
Adriana Scavuzzi ◽  
Carlos Noronha Neto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Case Control Study ◽  
Fetal Distress ◽  
Maternity Hospital ◽  
Case Control ◽  
Northeastern Brazil ◽  
Instrumental Delivery ◽  
Adjusted Risk ◽  
Control Study

Objective: obtaining information on the factors associated with episiotomy will be useful in sensitizing professionals to the need to minimize its incidence. Therefore, the objective of this study was to evaluate risk factors for episiotomy in pregnant women who had undergone vaginal delivery at a university maternity hospital in northeastern Brazil. Methods: a case-control study was conducted with pregnant women submitted to episiotomy (cases) and pregnant women not submitted to episiotomy (controls) between March 2009 and July 2010 at the Professor Fernando Figueira Integral Medicine Institute (IMIP) in Recife, Brazil, in a ratio of 1 case to 2 controls. The study variables consisted of: whether episiotomy was performed, demographic, obstetric and fetal characteristics (primiparity, analgesia, instrumental delivery, fetal distress, etc.), external factors (day and time of delivery, professional attending delivery) and factors directly related to delivery. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Multivariate analysis was performed to determine the adjusted risk of episiotomy. Results: a total of 522 women (173 cases and 349 controls) were included. It was found that deliveries with episiotomy were more likely to have been attended by staff physicians (OR = 1.88; 95%CI: 1.01 - 3.48), to have required forceps (OR = 12.31; 95%CI: 4.9 - 30.1) and to have occurred in primiparas (OR = 4.24; 95%CI: 2.61 - 6.89). The likelihood of a nurse having attended the delivery with episiotomy was significantly lower (OR = 0.29; 95%CI: 0.16 - 0.55). Conclusion: episiotomy was found to be strongly associated with deliveries attended by staff physicians, with primiparity, and with instrumental delivery, and was less common in deliveries attended by nurses.

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