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 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 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 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.

Risk factors for sporadicVibrio parahaemolyticusgastroenteritis in east China: a matched case-control study

2014 ◽  
Vol 143 (5) ◽  
pp. 1020-1028 ◽  
Author(s):  
W. X. YAN ◽  
Y. DAI ◽  
Y. J. ZHOU ◽  
H. LIU ◽  
S. G. DUAN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Multivariable Analysis ◽  
Antibiotic Use ◽  
Population Based ◽  
Case Control ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Matched Case ◽  
Control Study

SUMMARYTo determine risk factors for sporadicVibrio parahaemolyticusgastroenteritis, we conducted a population-based case-control study in sentinel hospital surveillance areas of Shanghai and Jiangsu province, China. Seventy-one patients with diarrhoea and confirmedV. parahaemolyticusinfections were enrolled, and they were matched with 142 controls for gender, age and residential area. From the multivariable analysis,V. parahaemolyticusinfections were associated with antibiotics taken during the 4 weeks prior to illness [odds ratio (OR) 8·1, 95% confidence interval (CI) 1·2–56·4)], frequent eating out (OR 3·3, 95% CI 1·1–10·1), and shellfish consumption (OR 3·2, 95% CI 1·0–9·9), with population-attributable fractions of 0·09, 0·25, and 0·14, respectively. Protective factors included keeping the aquatic products refrigerated (OR 0·4, 95% CI 0·1–0·9) and pork consumption (OR 0·2, 95% CI 0·1–0·8). Further study of the association ofV. parahaemolyticusgastroenteritis with prior antibiotic use and shellfish consumption is needed.

A case–control study of risk factors for multiple sclerosis in Iran

2011 ◽  
Vol 17 (5) ◽  
pp. 550-555 ◽  
Author(s):  
Alvaro Alonso ◽  
Stuart D Cook ◽  
Amir-Hadi Maghzi ◽  
Afshin A Divani
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Case Control Study ◽  
Past History ◽  
Multivariable Analysis ◽  
Case Control ◽  
Sunlight Exposure ◽  
Farm Animals ◽  
History Of ◽  
Control Study

Background: Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. Objective: The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. Methods: A case–control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. Results: In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53–0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46–28.78), but not in men (OR: 0.72, 95% CI: 0.31–1.68) ( p = 0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. Conclusions: Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.

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.

scholarly journals Case-Control Study of Risk Factors Associated with Feline and Canine Chronic Kidney Disease

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Paul C. Bartlett ◽  
James W. Van Buren ◽  
Andrew D. Bartlett ◽  
Chun Zhou
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Case Control Study ◽  
Clinical Signs ◽  
Case Control ◽  
Factors Associated ◽  
History Of ◽  
Bad Breath ◽  
Dog Owners ◽  
Control Study

An age-matched case-control study was initiated to determine the major risk factors associated with CKD in cats and dogs and to determine what clinical signs cat and dog owners observed before their veterinarian diagnosed their pet with CKD. When compared to controls, the feline cases were more likely to have had polydipsia and polyuria in the year before the owners' cats were diagnosed with CKD. In the dogs, increased water intake, increased urination, small size and a recent history of weight loss and bad breath were noticed by the dog owners before veterinary CKD diagnosis. Dog owners recognized abnormal drinking and urination behavior over half a year before their pet's veterinary diagnosis with CKD, and they recognized weight loss almost 4 months before CKD diagnosis. Bad breath was noticed 1.2 years before recognition of CKD by a veterinarian. Given that earlier CKD diagnosis should have been possible in most cases, clinical trials should proceed to measure the efficacy of early interventions.

scholarly journals Herd-level risk factors for chronic pleurisy in finishing pigs: a case-control study

2020 ◽  
Author(s):  
Outi Hälli ◽  
Minna Haimi-Hakala ◽  
Claudio Oliviero ◽  
Mari Heinonen
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Swine Influenza Virus ◽  
Clinical Signs ◽  
Case Control ◽  
Meat Inspection ◽  
Common Finding ◽  
Finishing Pigs ◽  
Herd Level ◽  
Control Study

Abstract Background Chronic pleurisy is a common finding in slaughtered pigs in post-mortem meat inspection. The prevalence of pleurisy has been increasing during the last decade also in Finland. The aim of this prospective case-control study was to search for environmental, infectious and management-related herd-level risk factors for pleurisy in the slaughterhouse. Altogether 46 Finnish pig herds, including 25 control (low pleurisy prevalence in meat inspection) and 21 case (high pleurisy) herds, were enrolled in the study and visited during the tenth week of the rearing period of finishing pigs. Herd personnel were asked about basic herd information, management and environmental factors. Selected pigs were examined clinically, environmental parameters were measured and 15 blood samples per herd were taken during herd visits. Antibodies against Actinobacillus pleuropneumonia serotype 2 (APP2) and ApxIV toxin and swine influenza virus were measured. After the slaughter of study pigs, meat inspection results of the batch were gathered from slaughterhouses. Multivariate logistic regression model was built to identify possible risk factors for a herd to be a case herd (i.e. having high pleurisy values). Results Finishing herd type and herd size were observed to act as risk factors. None of clinical signs of pigs, management-related factors or environmental measurements were associated with herd status. Conclusions As previously known, in endemic and subclinical infections such as APP, herd factors are important, but detailed risk factors seem to be difficult to identify.

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