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Nieto-Rosado M, Sands K, Portal EAR, Thomson KM, Carvalho MJ, Mathias J, Milton R, Dyer C, Akpulu C, Boostrom I, Hogan P, Saif H, Sanches Ferreira AD, Hender T, Portal B, Andrews R, Watkins WJ, Zahra R, Shirazi H, Muhammad A, Ullah SN, Jan MH, Akif S, Iregbu KC, Modibbo F, Uwaezuoke S, Audu L, Edwin CP, Yusuf AH, Adeleye A, Mukkadas AS, Mazarati JB, Rucogoza A, Gaju L, Mehtar S, Bulabula ANH, Whitelaw A, Roberts L, Chan G, Bekele D, Solomon S, Abayneh M, Metaferia G, Walsh TR. Colonisation of hospital surfaces from low- and middle-income countries by extended spectrum β-lactamase- and carbapenemase-producing bacteria. Nat Commun 2024; 15:2758. [PMID: 38553439 PMCID: PMC10980694 DOI: 10.1038/s41467-024-46684-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/06/2024] [Indexed: 04/02/2024] Open
Abstract
Hospital surfaces can harbour bacterial pathogens, which may disseminate and cause nosocomial infections, contributing towards mortality in low- and middle-income countries (LMICs). During the BARNARDS study, hospital surfaces from neonatal wards were sampled to assess the degree of environmental surface and patient care equipment colonisation by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). Here, we perform PCR screening for extended-spectrum β-lactamases (blaCTX-M-15) and carbapenemases (blaNDM, blaOXA-48-like and blaKPC), MALDI-TOF MS identification of GNB carrying ARGs, and further analysis by whole genome sequencing of bacterial isolates. We determine presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis. Higher prevalence of carbapenemases is observed in Pakistan, Bangladesh, and Ethiopia, compared to other countries, and are mostly found in surfaces near the sink drain. Klebsiella pneumoniae, Enterobacter hormaechei, Acinetobacter baumannii, Serratia marcescens and Leclercia adecarboxylata are dominant; ST15 K. pneumoniae is identified from the same ward on multiple occasions suggesting clonal persistence within the same environment, and is found to be identical to isolates causing neonatal sepsis in Pakistan over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines.
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Affiliation(s)
- Maria Nieto-Rosado
- Department of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK.
- Division of Infection and Immunity, Cardiff University, Cardiff, UK.
| | - Kirsty Sands
- Department of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Edward A R Portal
- Department of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kathryn M Thomson
- Department of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maria J Carvalho
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Department of Medical Sciences, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Jordan Mathias
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Rebecca Milton
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Calie Dyer
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Chinenye Akpulu
- Department of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Ian Boostrom
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Patrick Hogan
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Habiba Saif
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Ana D Sanches Ferreira
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Parasites and Microbes Programme, Wellcome Sanger Institute Hinxton, Hinxton, UK
| | - Thomas Hender
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Barbra Portal
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Robert Andrews
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - W John Watkins
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Rabaab Zahra
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Haider Shirazi
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Adil Muhammad
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Syed Najeeb Ullah
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Hilal Jan
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shermeen Akif
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | | | | | | | | | - Chinago P Edwin
- Department of Microbiology, Medway Maritime Hospital NHS Foundation Trust, Gillingham, Kent, UK
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Adeola Adeleye
- Murtala Muhammad Specialist Hospital, Kano City, Nigeria
| | | | | | - Aniceth Rucogoza
- The National Reference Laboratory, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Lucie Gaju
- The National Reference Laboratory, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Shaheen Mehtar
- Unit of IPC, Stellenbosch University, Cape Town, South Africa
- Infection Control Africa Network, Cape Town, South Africa
| | - Andrew N H Bulabula
- Infection Control Africa Network, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Lauren Roberts
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa
| | - Grace Chan
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics and Child Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Obstetrics and Gynecology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Semaria Solomon
- Department of Microbiology, Immunology and Parasitology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- Department of Pediatrics and Child Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- Department of Microbiology, Immunology and Parasitology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Timothy R Walsh
- Department of Biology, Ineos Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
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Workneh R, Abadi M, Perez K, Rent S, Weiss EM, Kukora S, Brandon O, Barbut G, Rahiem S, Wallie S, Mhango J, Shayo BC, Saidi F, Metaferia G, Abayneh M, Valentine GC. Environmental Justice: A Missing Core Tenet of Global Health. Am J Bioeth 2024; 24:20-23. [PMID: 38394016 DOI: 10.1080/15265161.2024.2303132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
| | | | | | | | - Elliott Mark Weiss
- University of Washington School of Medicine
- Seattle Children's Hospital
- Treuman Katz Center for Pediatric Bioethics
| | | | | | | | | | | | - Joseph Mhango
- Baylor College of Medicine Children's Foundation-Malawi
| | - Benjamin C Shayo
- Baylor College of Medicine Children's Foundation-Malawi
- Baylor College of Medicine
| | | | | | | | - Gregory C Valentine
- University of Washington School of Medicine
- University of Washington School of Dentistry
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Ehret DEY, Demtse Gebremedhin A, Hadgu Berhe A, Hailu Y, Metaferia G, Kessler K, Kessler R, Dunn M, Golan A, Stavel M, Belava J, Horbar JD, Edwards EM, Worku B, Dunn M, Abayneh M. High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress. Acta Paediatr 2023; 112:2329-2337. [PMID: 37675588 DOI: 10.1111/apa.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/13/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
AIM To assess the inter-rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score-based treatment for preterm infants with respiratory distress. METHODS We included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4. RESULTS Of the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score-based treatment. CONCLUSION Incorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near-perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score-based treatment recommendations. These results highlight an opportunity for task-shifting assessments and empowering nurses.
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Affiliation(s)
- Danielle E Y Ehret
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Vermont Oxford Network, Burlington, Vermont, United States
| | | | - Amanuel Hadgu Berhe
- Department of Pediatrics and Child Health, Mekelle University, Mekelle, Ethiopia
| | - Yohanes Hailu
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
| | - Gesit Metaferia
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kaitlin Kessler
- University of Vermont Medical Center, Burlington, Vermont, United States
| | - Ryan Kessler
- University of Vermont Medical Center, Burlington, Vermont, United States
| | - Marie Dunn
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Miroslav Stavel
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Jeffrey D Horbar
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Vermont Oxford Network, Burlington, Vermont, United States
| | - Erika M Edwards
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Vermont Oxford Network, Burlington, Vermont, United States
- University of Vermont College of Engineering and Mathematical Sciences, Burlington, Vermont, United States
| | - Bogale Worku
- Ethiopian Pediatrics Society, Addis Ababa, Ethiopia
| | - Michael Dunn
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mahlet Abayneh
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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4
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Milton R, Gillespie D, Dyer C, Taiyari K, Carvalho MJ, Thomson K, Sands K, Portal EAR, Hood K, Ferreira A, Hender T, Kirby N, Mathias J, Nieto M, Watkins WJ, Bekele D, Abayneh M, Solomon S, Basu S, Nandy RK, Saha B, Iregbu K, Modibbo FZ, Uwaezuoke S, Zahra R, Shirazi H, Najeeb SU, Mazarati JB, Rucogoza A, Gaju L, Mehtar S, Bulabula ANH, Whitelaw AC, Walsh TR, Chan GJ, Odumade O, Ambachew R, Yohannes ZG, Metaferia G, Workneh R, Biteye T, Mohammed YZ, Teklu AM, Nigatu B, Gezahegn W, Chakravorty PS, Naha S, Mukherjee A, Umar KM, Akunna AV, Nsude Q, Uke I, Okenu MJ, Akpulu C, Mmadueke C, Yakubu S, Audu L, Idris N, Gambo S, Ibrahim J, Chinago E, Yusuf A, Gwadabe S, Adeleye A, Aliyu M, Muhammad A, Kassim A, Mukaddas AS, Khalid RY, Alkali FI, Muhammad MY, Tukur FM, Muhammad SM, Shittu A, Bello M, Sa ad FH, Zulfiqar S, Muhammad A, Jan MH, Paterson L. Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study. The Lancet Global Health 2022; 10:e661-e672. [PMID: 35427523 PMCID: PMC9023753 DOI: 10.1016/s2214-109x(22)00043-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 02/08/2023] Open
Abstract
Background Neonatal sepsis is a primary cause of neonatal mortality and is an urgent global health concern, especially within low-income and middle-income countries (LMICs), where 99% of global neonatal mortality occurs. The aims of this study were to determine the incidence and associations with neonatal sepsis and all-cause mortality in facility-born neonates in LMICs. Methods The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) study recruited mothers and their neonates into a prospective observational cohort study across 12 clinical sites from Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Data for sepsis-associated factors in the four domains of health care, maternal, birth and neonatal, and living environment were collected for all mothers and neonates enrolled. Primary outcomes were clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality in neonates during the first 60 days of life. Incidence proportion of livebirths for clinically suspected sepsis and laboratory-confirmed sepsis and incidence rate per 1000 neonate-days for all-cause mortality were calculated. Modified Poisson regression was used to investigate factors associated with neonatal sepsis and parametric survival models for factors associated with all-cause mortality. Findings Between Nov 12, 2015 and Feb 1, 2018, 29 483 mothers and 30 557 neonates were enrolled. The incidence of clinically suspected sepsis was 166·0 (95% CI 97·69–234·24) per 1000 livebirths, laboratory-confirmed sepsis was 46·9 (19·04–74·79) per 1000 livebirths, and all-cause mortality was 0·83 (0·37–2·00) per 1000 neonate-days. Maternal hypertension, previous maternal hospitalisation within 12 months, average or higher monthly household income, ward size (>11 beds), ward type (neonatal), living in a rural environment, preterm birth, perinatal asphyxia, and multiple births were associated with an increased risk of clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality. The majority (881 [72·5%] of 1215) of laboratory-confirmed sepsis cases occurred within the first 3 days of life. Interpretation Findings from this study highlight the substantial proportion of neonates who develop neonatal sepsis, and the high mortality rates among neonates with sepsis in LMICs. More efficient and effective identification of neonatal sepsis is needed to target interventions to reduce its incidence and subsequent mortality in LMICs. Funding Bill & Melinda Gates Foundation.
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Solomon S, Akeju O, Odumade OA, Ambachew R, Gebreyohannes Z, Van Wickle K, Abayneh M, Metaferia G, Carvalho MJ, Thomson K, Sands K, Walsh TR, Milton R, Goddard FGB, Bekele D, Chan GJ. Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis. PLoS One 2021; 16:e0255410. [PMID: 34343185 PMCID: PMC8330902 DOI: 10.1371/journal.pone.0255410] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics. OBJECTIVES Our goal was to estimate the prevalence of antibiotic-resistant gram-negative bacteremia and identify risk factors for antibiotic resistance, among newborns with GNB sepsis. METHODS At a tertiary hospital in Ethiopia, we enrolled a cohort pregnant women and their newborns, between March and December 2017. Newborns who were followed up until 60 days of life for clinical signs of sepsis. Among the newborns with clinical signs of sepsis, blood samples were cultured; bacterial species were identified and tested for antibiotic susceptibility. We described the prevalence of antibiotic resistance, identified newborn, maternal, and environmental factors associated with multidrug resistance (MDR), and combined resistance to ampicillin and gentamicin (AmpGen), using multivariable regression. RESULTS Of the 119 newborns with gram-negative bacteremia, 80 (67%) were born preterm and 82 (70%) had early-onset sepsis. The most prevalent gram-negative species were Klebsiella pneumoniae 94 (79%) followed by Escherichia coli 10 (8%). Ampicillin resistance was found in 113 cases (95%), cefotaxime 104 (87%), gentamicin 101 (85%), AmpGen 101 (85%), piperacillin-tazobactam 47 (39%), amikacin 10 (8.4%), and Imipenem 1 (0.8%). Prevalence of MDR was 88% (n = 105). Low birthweight and late-onset sepsis (LOS) were associated with higher risks of AmpGen-resistant infections. All-cause mortality was higher among newborns treated with ineffective antibiotics. CONCLUSION There was significant resistance to current first-line antibiotics and cephalosporins. Additional data are needed from primary care and community settings. Amikacin and piperacillin-tazobactam had lower rates of resistance; however, context-specific assessments of their potential adverse effects, their local availability, and cost-effectiveness would be necessary before selecting a new first-line regimen to help guide clinical decision-making.
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Affiliation(s)
- Semaria Solomon
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Oluwasefunmi Akeju
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Oludare A. Odumade
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rozina Ambachew
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Kimi Van Wickle
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mahlet Abayneh
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maria J. Carvalho
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Medical Sciences, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Kathryn Thomson
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Kirsty Sands
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Timothy R. Walsh
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, Ineos Oxford Institute of Antimicrobial Research, University of Oxford, Oxford, United Kingdom
| | - Rebecca Milton
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - Delayehu Bekele
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Grace J. Chan
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Metaferia G, Abayneh M, Aynalem S, Demisse AG, Demtse AG, Eshetu B, Mekasha A, Worku B, Nigussie AK, McClure EM, Goldenberg RL, Muhe LM. Antenatal Steroid Utilization in Ethiopia. Glob Pediatr Health 2021; 8:2333794X21990344. [PMID: 33614845 PMCID: PMC7868499 DOI: 10.1177/2333794x21990344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022] Open
Abstract
Background. Administration of antenatal corticosteroids to pregnant mothers is one of the most effective interventions to decrease preterm neonatal mortality. In this study we assessed antenatal steroid utilization by the mother and its effect on preterm babies. Method. Two years prospective, multicenter, observational study was conducted in selected hospitals of Ethiopia. Significance of the study outcomes was tested by chi-square and binary logistic regression. Result. Out of 4919 participants, 1575 preterm babies whose gestational ages were below 35 weeks were included in the study. Use of antenatal dexamethasone was 37.5% among study participants. The risk of early onset neonatal sepsis 235 (40.4%) was higher in preterm babies whose mother took antenatal dexamethasone (P-value .002) than those who did not. Conclusion. Antenatal dexamethasone use in our study was comparable with other low and middle-income countries. Risk of early onset neonatal sepsis was higher among infants whose mother took antenatal dexamethasone.
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Affiliation(s)
- Gesit Metaferia
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sara Aynalem
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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7
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Aynalem S, Abayneh M, Metaferia G, Demissie AG, Gidi NW, Demtse AG, Berta H, Worku B, Nigussie AK, Mekasha A, Tazu Bonger Z, McClure EM, Goldenberg RL, Muhe LM. Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia. Glob Pediatr Health 2021; 7:2333794X20985809. [PMID: 33457466 PMCID: PMC7783876 DOI: 10.1177/2333794x20985809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/28/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background. Hyperbilirubinemia is prevalent and protracted in
preterm infants. This study assessed the pattern of hyperbilirubinemia in
preterm infants in Ethiopia. Methods. This study was part of
multi-centered prospective, cross-sectional, observational study that determined
causes of death among preterm infants. Jaundice was first identified based on
clinical visual assessment. Venous blood was then sent for total and direct
serum bilirubin level measurements. For this study, a total serum bilirubin
level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia.
Based on the bilirubin level and clinical findings, the final diagnoses of
hyperbilirubinemia and associated complications were made by the physician.
Result. A total of 4919 preterm infants were enrolled into
the overall study, and 3852 were admitted to one of the study’s newborn
intensive care units. Of these, 1779 (46.2%) infants were diagnosed with
hyperbilirubinemia. Ten of these (0.6%) developed acute bilirubin
encephalopathy. The prevalence of hyperbilirubinemia was 66.7% among the infants
who were less than 28 weeks of gestation who survived. Rh incompatibility
(P = .002), ABO incompatibility
(P = .0001), and sepsis (P = .0001) were
significantly associated with hyperbilirubinemia. Perinatal asphyxia
(P-value = 0.0001) was negatively associated with
hyperbilirubinemia. Conclusion. The prevalence of
hyperbilirubinemia in preterm babies admitted to neonatal care units in Ethiopia
was high. The major risk factors associated with hyperbilirubinemia in preterm
babies in this study were found to be ABO incompatibility, sepsis, and Rh
isoimmunization.
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Affiliation(s)
- Sara Aynalem
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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8
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Tigabu Kebede Z, Matebe YH, Demisse AG, Yimer MA, Mekasha A, Worku A, Demtse Gebremedhin A, McClure EM, Nigussie AK, Worku B, Gidi NW, Metaferia G, Goldenberg RL, Muhe LM. Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome. Glob Pediatr Health 2020; 7:2333794X20960264. [PMID: 33088853 PMCID: PMC7545762 DOI: 10.1177/2333794x20960264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/28/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies <7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm3, and 159 340 cells/mm3, respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was <5000 cells/mm3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was <7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was <50 000 cells/mm3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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Demtse AG, Pfister RE, Nigussie AK, McClure EM, Ferede YG, Tazu Bonger Z, Mekasha A, Demisse AG, Gidi NW, Metaferia G, Worku B, Goldenberg RL, Muhe LM. Hypothermia in Preterm Newborns: Impact on Survival. Glob Pediatr Health 2020; 7:2333794X20957655. [PMID: 32974416 PMCID: PMC7493265 DOI: 10.1177/2333794x20957655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/21/2023] Open
Abstract
Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates (<37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were the main factors associated with hypothermia. The very high prevalence and association with mortality warrants quality improvement interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gesit Metaferia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
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Muhe LM, McClure EM, Nigussie AK, Mekasha A, Worku B, Worku A, Demtse A, Eshetu B, Tigabu Z, Gizaw MA, Workneh N, Girma A, Asefa M, Portales R, Bekele T, Bezabih M, Metaferia G, Gashaw M, Abebe B, Berta H, Alemu A, Desta T, Hailu R, Gebreyesus G, Aynalem S, Abdissa AL, Pfister R, Bonger ZT, Gizaw S, Abebe T, Berhane MA, Bekuretsion Y, Dhaded S, Patterson J, Goldenberg RL. Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study. Lancet Glob Health 2020; 7:e1130-e1138. [PMID: 31303299 PMCID: PMC6639243 DOI: 10.1016/s2214-109x(19)30220-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/17/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. METHODS We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. FINDINGS Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888). INTERPRETATION Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lulu M Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Durham, NC, USA
| | | | - Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Demtse
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Mahlet A Gizaw
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Mesfin Asefa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ramon Portales
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Gesit Metaferia
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | - Tigist Desta
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahell Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sara Aynalem
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Riccardo Pfister
- Neonatology Unit, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Solomon Gizaw
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Yonas Bekuretsion
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sangappa Dhaded
- Women's and Children's Health Research Unit, KAHER, J N Medical College, Belgaum, India
| | - Janna Patterson
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Muhe LM, McClure EM, Mekasha A, Worku B, Worku A, Dimtse A, Gebreyesus G, Tigabu Z, Abayneh M, Workneh N, Eshetu B, Girma A, Asefa M, Portales R, Arayaselassie M, Gebrehiwot Y, Bekele T, Bezabih M, Metaferia G, Gashaw M, Abebe B, Geleta A, Shehibo A, Hailu Y, Berta H, Alemu A, Desta T, Hailu R, Patterson J, Nigussie AK, Goldenberg RL. A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol. Reprod Health 2018; 15:116. [PMID: 29945680 PMCID: PMC6020308 DOI: 10.1186/s12978-018-0555-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. METHODS This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. DISCUSSION This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.
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Affiliation(s)
- Lulu M. Muhe
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amha Mekasha
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Dimtse
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Mahlet Abayneh
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Asefa
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ramon Portales
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yirgu Gebrehiwot
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Gesit Metaferia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Hailu Berta
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tigist Desta
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Hailu
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Quinonez SC, Yeshidinber A, Lourie MA, Bekele D, Mekonnen Y, Nigatu B, Metaferia G, Jebessa S. Introducing medical genetics services in Ethiopia using the MiGene Family History App. Genet Med 2018; 21:451-458. [PMID: 29892089 DOI: 10.1038/s41436-018-0069-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/09/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Almost all low-income countries and many middle-income countries lack the capacity to deliver medical genetics services. We developed the MiGene Family History App (MFHA), which assists doctors with family history collection and population-level epidemiologic analysis. The MFHA was studied at St. Paul's Hospital in Addis Ababa, Ethiopia. METHODS A needs assessment was used to assess Ethiopian physicians' experience with genetics services. The MFHA then collected patient data over a 6-month period. RESULTS The majority of doctors provide genetics services, with only 16% reporting their genetics knowledge is sufficient. A total of 1699 patients from the pediatric ward (n = 367), neonatal intensive care unit (NICU) (n = 477), and antenatal clinic (n = 855) were collected using the MFHA with a 4% incidence of a MFHA-screened condition present. The incidence was 11.7% in the pediatric ward, 3% in the NICU, and 0.5% in the antenatal clinic. Heart malformations (5.5% of patients) and trisomy 21 (4.4% of patients) were the most common conditions in the pediatric ward. CONCLUSION Medical genetics services are needed in Ethiopia. As other countries increase their genetics capacity, the MFHA can provide fundamental genetics services and collect necessary epidemiologic data.
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Affiliation(s)
- Shane C Quinonez
- Department of Pediatrics and Communicable Diseases, Division of Genetics, Metabolism and Genomic Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Abate Yeshidinber
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yemisrach Mekonnen
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Balkachew Nigatu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Solomie Jebessa
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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