Elena Folgosa

A case control study of chorioamniotic infection and histological chorioamnionitis in stillbirth.

In order to elucidate the role and aetiology of chorioamnionitis in stillbirth a case referent study was carried out in 58 pregnant women with late foetal death (cases) and in 58 pregnant women at term with live foetus (referents) matched for age and parity in Maputo Mozambique. Samples from women, stillborns and liveborns, were collected for microbiological and histological assessment. Histological chorioamnionitis was diagnosed in 96% of the cases and in 67% of the referents (OR=13.5; 95% CI: 2.9–123.9). Escherichia coli was the species most frequently isolated in stillborns; in 14/16 (88%) cases it was isolated from intracardiac fluid. E. coli was associated with chorioamnionitis in 28% of the stillborns as compared to 5% of the referents (OR=6.9; 95% CI: 1.4–65.4). No group B streptococci were recovered from any placenta or newborn. Vasculitis was present in 12 (21%) cases and in 3 (5%) referents (OR=4.8; 95%, CI: 1.2–27.7). Histological chorioamnionitis was thus associated with stillbirth. E. coli was common in stillborns. The presence of vasculitis in one fifth of the stillborns indicated that the foetus was alive at the onset of infection.

Syphilis seroprevalence among pregnant women and its role as a risk factor for stillbirth in Maputo, Mozambique.

OBJECTIVE: To elucidate the role of current syphilis as a risk factor for foetal death. METHODS: Sera were obtained from 57 women with third trimester foetal death (cases) and 58 women with foetus alive (controls) matched for age and parity. All sera reactive in qualitative Rapid Plasma Reagin (RPR) analyses were tested with serial twofold dilutions to determine endpoint flocculation titres and tested with the micro-haemagglutination assay for Treponema pallidum (MHA-TP). Placental biopsies were sectioned and stained by haematoxylin-eosin and Warthin-Starry for light microscopy. SETTING: Central Hospital, in Maputo, Mozambique, from January 1990 to June 1991. RESULTS: The MHA-TP was reactive in 42% of cases and in 12% of controls (OR = 5.3; 95% CI: 1.9-15.4). The RPR card test was reactive at the dilution of 1.32 or greater in 28% of cases and in 7% of controls. All these results were confirmed by MHA-TP (OR = 5.3; 95% CI: 1.5-15.4). In 9/28 (32%) MHA-TP seroreactive women (7 cases and 2 controls) placental morphological changes indicated syphilitic infection. CONCLUSION: MHA-TP seroreactivity and high titre RPR were associated with stillbirth. Morphological changes presumptive of syphilis infection were found in 32% placentas histologically studied. Syphilis is a risk factor for foetal death in Maputo, Mozambique.

Genital infections in the aetiology of late fetal death: an incident case-referent study.

Women with prelabour fetal death in the third trimester were recruited in order to study the association between intra-uterine death and maternal genital colonization of bacteria. Fifty-eight women with verified fetal death were compared with a group of 58 women matched for age, parity and gestational length (the first referent group) and with women delivering liveborn neonates (second referent group). Cultures from the vagina, the endocervix, the amniotic fluid, the placenta, the conjunctivae of the newborn and the secretion of gastric aspirate of the newborn were carried out. Blood was taken for haemoglobin, thick film (malaria) and syphilis and HIV serology. Cases were more affected by previous stillbirths than first referents (OR = 11.88). Preterm delivery was significantly more common in cases than in second referents (OR = 57.70). Cases had significantly more often < 3 ANC visits (OR = 2.81). Cases had a lower body mass index than first referents (OR = 2.38). Temperature > or = 37 degrees C was 12 times more frequent in cases than in first referents (OR = 21.20) and four times more frequent than in second referents (OR = 6.60). Average birth weight among stillborns was 1954 g and in liveborns 3223 g (P = 0.001). The corresponding prevalence of LBW was 78% in cases and 0% among second referents (P < 0.001). Histological chorioamnionitis was significantly prevalent in cases than in second referents (OR = 4.97). Syphilis was significantly more common in cases than in first (OR = 7.71) and in second referents (OR = 5.30).(ABSTRACT TRUNCATED AT 250 WORDS)

Infertile Women in Developing Countries at Potentially High Risk of HIV Transmission

One hundred infertile women and 200 proven fertile women were recruited in Montepuez District, northern Mozambique, in order to elucidate the risk of syphilis and HIV seropositivity. TPHA seropositivity occurred in 55.0 per cent of infertile and 18.5 per cent of fertile women (OR 4.7; 95% CI 3.0-7.4). Among women with 2 lifetime spouses, 64.6 per cent of infertile women were TPHA seropositive, compared to 22.3 per cent of fertile women (OR 7.1; 95% CI 3.6-14.1). Three women (all infertile had HIV-1 antibodies and one, fertile, had HIV-2 antibodies. It concluded that infertile women constitute a group at potentially high risk of HIV infection once this infection is introduced into the community. (Afr J Reprod Health 1999; 3 (1): 98 - 102) Key Words : Infertility, syphilis, HIV infection

An Incident Case-Referent Study of Threatening Preterm Birth and Genital Infection

A total of 53 pregnant Mozambican women identified as having painful uterine contractions in the preterm period were studied and compared to referents, matched for age, parity, and gestational length, without such contractions. Both groups were studied regarding socio-economic and obstetric background factors, current clinical features, and microbiological findings in the lower genital tract. Cases tended to seek antenatal care earlier than referents. Salaried work outside the home was more common among cases (OR = 16.9). It was shown that affected cases had significantly more antenatal card risk factors (OR = 3.4) and that 10 times more cases than referents had elevated body temperature (OR = 16.7). Anaemia was more common among cases than among referents (OR = 3.7) and malaria parasitaemia was over-represented among cases (OR = 12.4). Mid-upper-arm circumference was shorter among cases than among referents (OR = 2.4). Anaerobic bacteria tended to be isolated from endocervix more often among cases than among referents (OR = 2.4). Only one woman in the study was HIV-1-positive. It is concluded that febrile infection is strongly associated with preterm labour and that salaried work outside home, anaemia, and malaria are significant risk factors in the setting studied.

Risk factors in puerperal endometritis-myometritis : an incident case-referent study

Postpartum endometritis-myometritis (PPEM) was identified in 51 women after vaginal delivery, who were compared with 51 healthy referent parturients, matched for age, parity and days postpartum. Socio-economic background data, past and current obstetric history and clinical data from recent delivery were analyzed. Endocervical and intracavitary cultures and blood cultures were performed and serological analyses of syphilis and HIV antibodies were carried out. No socio-economic factor studied discriminated significantly between cases and referents. Previous stillbirth (OR 9.44) and previous low-birthweight delivery (OR 3.90) occurred significantly more often among cases. In recently past pregnancy preterm delivery (OR 10.07), low birthweight (OR 16.55) and serious neonatal morbidity (OR 14.27) were significantly more common among cases. Cases and referents differed also significantly in body mass index < 22.5 (OR 3.41), left mid-upper-arm circumference < 25 cm (OR 2.66), haemoglobin < 100 g/l (OR 3.12) and high-risk classification in antenatal care (OR 11.95). Bacterial intracavitary cultures tended to be positive and have anaerobes more frequently in cases than in referents. It is concluded that women with PPEM in the setting studied belong to a group at risk also regarding adverse fetal outcome, both in recently past and in previous pregnancies.

Low prevalence of HIV and other sexually transmitted infections in young women attending a youth counselling service in Maputo, Mozambique

Objectives  To determine the prevalence of sexually transmitted infections (STIs) in a group of young women attending the Adolescent and Youth Friendly Service, in Maputo, Mozambique, and to evaluate their level of knowledge, practices and attitudes about STI.

A Case-Control Study on Post-Caesarean Endometritis-Myometritis in Mozambique

Post-caesarean endometritis-myometritis (PCEM) was diagnosed in 49 Mozambican women. They were compared with 47 control women without signs of PCEM after caesarean section. The patients and controls were matched for age, parity and days post partum. Features of the socio-economic background and of past and current obstetric history were registered. Endocervical, intracavitary and blood cultures were carried out. Screening for syphilis seropositivity and HIV-1 and HIV-2 antibodies was performed. Socio-economic and obstetric background factors were similarly distributed in cases and referents, though previous caesarean section was less frequent among cases than among referents (OR 0.12). Moderate high-risk factors in existing antenatal card tended to be more frequent among cases than among referents (OR 3.29). Microbiological findings indicated more anaerobes in the vagina, in the endocervix and in the uterine cavity, though the differences only approached significance. It is concluded that women with PCEM in the setting studied expose few characteristic background features discriminating them from women with uneventful post-caesarean outcome. Further research efforts should be directed towards case-control studies with focus upon surgical factors and on a more comprehensive microbiology and serology approach.

Comparison of the performance of rapid HIV tests using samples collected for surveillance in Mozambique

Mozambique had low HIV prevalence until the mid‐1990s, but recent data indicate increasing rates. There is little information on HIV‐2. Therefore, HIV seroprevalence was assessed among pregnant women and field‐ready HIV diagnostic strategies were evaluated. A total of 6,930 samples collected by three health centers from 2002 to 2005 were tested on site by nurses with two simple/rapid tests, Determine HIV‐1/2 (Abbott Laboratories; screening) and Uni‐Gold HIV (Trinity Biotech; confirmation), which is the national HIV testing strategy. The prevalence of HIV was 14.0% (2002), 17.8% (2003), 16.5% (2004), and 20.2% (2005). A subset of 888 samples collected 2003 was sent to the Central Microbiology Laboratory, Maputo for evaluation of tests and testing strategies. The assays included for comparison were Capillus HIV‐1/HIV‐2 (Trinity Biotech), DoubleCheckGold HIV‐1&2 (Orgenics) and Enzygnost Anti‐HIV‐1/2 Plus (Behringwerke, reference ELISA). Confirmation of reactive samples was done by Uni‐Gold HIV and ImmunoComb II HIV‐1&2 BiSpot (for HIV type differentiation). The Capillus HIV‐1/ HIV‐2 + ImmunoComb II HIV‐1&2 BiSpot combination was the gold standard. The sensitivity of the rapid/simple screening assays (Determine HIV‐1/2, DoubleCheckGold HIV‐1&2) was 100% (N = 160) and their (initial) specificities were 99.6% and 99.7%, respectively. Repeated testing and combinations of assays increased the specificity. Four suspected cases of recent seroconversion were found. Together with the increasing prevalence rates, this may indicate that Mozambique is a high‐incidence area, although further studies are needed to confirm this. Testing strategies for on‐site screening and confirmation based on the combination of Determine HIV‐1/2, Uni‐Gold HIV and DoubleCheckGold HIV‐1&2 are well suited for local field use. J. Med. Virol. 81:1991–1998, 2009.

Low birth weight and genital infections : an incident case-referent study

In an attempt to elucidate the potential association between genital infections and low birth weight (LBW) births, 51 women with LBW neonates were identified and compared to 51 women with normal birthweight (NBW) neonates. Both groups were matched according to age and parity. All women were subjected to interviews regarding socioeconomic background and obstetric history. The were examined clinical and tested regarding serum haemoglobin, malaria parasitaemia, syphilis and HIV serology. Cultures were taken from the vagina, endocervix, amniotic fluid and from various sites of newborn, including the conjunctivae and the stomach and from the interior of the placenta. Whilst socioeconomic background factors did not differ among cases and referents, previous neonatal death did. Significant differences were also found in mid-upper-arm circumference (OR 3.08) and body mass index (OR 6.00). The prevalence of alleged risk factors according to the antenatal card was similar among cases and referents. Birthweight < 2,000 g was significantly more often associated with chorioamnionitis than birthweight between 2,000 and 2,499 g (OR 5.46). Bacteriological findings did not show significant differences in cases and referents. Haemoglobin values and prevalence of malaria parasitaemia were similar as was the neonatal mortality. It is concluded that LBW births is difficult to predict by use of alleged risk factors in existing antenatal cards.