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Comparison of maternal and neonatal outcomes of COVID-19 before and after SARS-CoV-2 omicron emergence in maternity facilities in Malawi (MATSurvey): data from a national maternal surveillance platform.
Mndala, Leonard; Monk, Edward J M; Phiri, Deborah; Riches, Jennifer; Makuluni, Regina; Gadama, Luis; Kachale, Fannie; Bilesi, Rosemary; Mbewe, Malangizo; Likaka, Andrew; Chapuma, Chikondi; Kumwenda, Moses; Maseko, Bertha; Ndamala, Chifundo; Kuyere, Annie; Munthali, Laura; Henrion, Marc Y R; Masesa, Clemens; Lissauer, David.
  • Mndala L; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Monk EJM; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi. Electronic address: emonk@mlw.mw.
  • Phiri D; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Riches J; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Makuluni R; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Gadama L; Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Kachale F; Ministry of Health, Lilongwe, Malawi.
  • Bilesi R; Ministry of Health, Lilongwe, Malawi.
  • Mbewe M; Ministry of Health, Lilongwe, Malawi.
  • Likaka A; Malawi Blood Transfusion Services, Blantyre, Malawi; Universidade Federal de Pernambuco, Recife, Brazil.
  • Chapuma C; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Kumwenda M; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Maseko B; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Ndamala C; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Kuyere A; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Munthali L; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi.
  • Henrion MYR; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK.
  • Masesa C; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK.
  • Lissauer D; Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi; University of Liverpool, Liverpool, UK.
Lancet Glob Health ; 10(11): e1623-e1631, 2022 11.
Article in English | MEDLINE | ID: covidwho-2096189
ABSTRACT

BACKGROUND:

Outcomes of omicron-associated COVID-19 in pregnancy have not been reported from low-resource settings, and data from sub-Saharan Africa before the emergence of omicron are scarce. Using a national maternal surveillance platform (MATSurvey), we aimed to compare maternal and neonatal outcomes of COVID-19 in Malawi during the omicron wave to the preceding waves of beta and delta.

METHODS:

All pregnant and recently pregnant patients, up to 42 days following delivery, admitted to 33 health-care facilities throughout Malawi with symptomatic, test-proven COVID-19 during the second (beta [B.1.351] January to April, 2021), third (delta [B.1.617.2] June to October, 2021), and fourth (omicron [B.1.1.529] December 2021 to March, 2022) waves were included, with no age restrictions. Demographic and clinical features, maternal outcomes of interest (severe maternal outcome [a composite of maternal near-miss events and maternal deaths] and maternal death), and neonatal outcomes of interest (stillbirth and death during maternal stay in the health-care facility of enrolment) were compared between the fourth wave and the second and third waves using Fisher's exact test. Adjusted odds ratios (ORs) for maternal outcomes were estimated using mixed-effects logistic regression.

FINDINGS:

Between Jan 1, 2021, and March 31, 2022, 437 patients admitted to 28 health-care facilities conducting MATSurvey had symptoms of COVID-19. SARS-CoV-2 infection was confirmed in 261 patients; of whom 76 (29%) had a severe maternal outcome and 45 (17%) died. These two outcomes were less common during the fourth wave (omicron dominance) than the second wave (adjusted OR of severe maternal

outcome:

3·96 [95% CI 1·22-12·83], p=0·022; adjusted OR of maternal death 5·65 [1·54-20·69], p=0·0090) and the third wave (adjusted OR 3·18 [1·03-9·80], p=0·044; adjusted OR 3·52 [0·98-12·60], p=0·053). Shortness of breath was the only symptom associated with poor maternal outcomes of interest (p<0·0001), and was less frequently reported in the fourth wave (23%) than in the second wave (51%; p=0·0007) or third wave (50%; p=0·0004). The demographic characteristics and medical histories of patients were similar across the three waves. During the second and third waves, 12 (13%) of 92 singleton neonates were stillborn or died during maternal stay in the health-care facility of enrolment, compared with 0 of the 25 born in the fourth wave (p=0·067 vs preceding waves combined).

INTERPRETATION:

Maternal and neonatal outcomes from COVID-19 were less severe during the fourth wave of the SARS-CoV-2 pandemic in Malawi, during omicron dominance, than during the preceding beta and delta waves.

FUNDING:

Bill & Melinda Gates Foundation, Wellcome Trust, and the National Institute for Health and Care Research. TRANSLATION For the Chichewa translation of the abstract see Supplementary Materials section.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pregnancy Complications, Infectious / Maternal Death / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Variants Limits: Female / Humans / Infant, Newborn / Pregnancy Country/Region as subject: Africa Language: English Journal: Lancet Glob Health Year: 2022 Document Type: Article Affiliation country: S2214-109X(22)00359-X

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pregnancy Complications, Infectious / Maternal Death / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Variants Limits: Female / Humans / Infant, Newborn / Pregnancy Country/Region as subject: Africa Language: English Journal: Lancet Glob Health Year: 2022 Document Type: Article Affiliation country: S2214-109X(22)00359-X