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Observational Study
. 2021 Jul 1;16(7):e0254131.
doi: 10.1371/journal.pone.0254131. eCollection 2021.

Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study

Susannah L Woodd  1 , Abdunoor M Kabanywanyi  2 , Andrea M Rehman  1 , Oona M R Campbell  1 , Asila Kagambo  2 , Warda Martiasi  2 , Louise M TinaDay  1 , Alexander M Aiken  1 , Wendy J Graham  1
Affiliations
Observational Study

Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study

Susannah L Woodd et al. PLoS One. .

Erratum in

Abstract

Introduction: Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth in Dar es Salaam.

Methods: We recruited postnatal women from two tertiary hospitals and conducted telephone interviews 7 and 28 days after delivery. Maternal infection (endometritis, caesarean or perineal wound, or urinary tract infection) and newborn infection (umbilical cord or possible severe bacterial infection) were identified using hospital case-notes at the time of birth and self-reported symptoms. Adjusted Cox regression models were used to assess the association between potential risk-factors and infection.

Results: We recruited 879 women and interviewed 791 (90%). From day 0-7, 6.7% (49/791) women and 6.2% (51/762) newborns developed infection. Using full follow-up data, the infection rate was higher in women with caesarean childbirth versus women with a vaginal delivery (aHR 1.93, 95%CI 1.11-3.36). Only 24% of women received pre-operative antibiotic prophylaxis before caesarean section. Infection was higher in newborns resuscitated at birth versus newborns who were not resuscitated (aHR 4.45, 95%CI 2.10-9.44). At interview, 66% (37/56) of women and 88% (72/82) of newborns with possible infection had sought health-facility care.

Conclusions: Telephone surveillance identified a substantial risk of postnatal infection, including cases likely to have been missed by hospital-based data-collection alone. Risk of maternal endometritis and newborn possible severe bacterial infection were consistent with other studies. Caesarean section was the most important risk-factor for maternal infection. Improved implementation of pre-operative antibiotic prophylaxis is urgently required to mitigate this risk.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: SLW, AMK, AK, WM and WJG received personal salary funded by The Soapbox Collaborative for their work on the study. SLW received a Research Degree Travel Grant from LSHTM. AMR received salary from the UK Medical Research Council and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. Other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow diagram.
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