Correction: Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014-2018.

[This corrects the article DOI: 10.1371/journal.pone.0269385.].

Seroprevalence of SARS-CoV-2 antibodies and retrospective mortality in two African settings: Lubumbashi, Democratic Republic of the Congo and Abidjan, Côte d'Ivoire.

Although seroprevalence studies have demonstrated the wide circulation of SARS-COV-2 in African countries, the impact on population health in these settings is still poorly understood. Using representative samples of the general population, we evaluated retrospective mortality and seroprevalence of anti-SARS-CoV-2 antibodies in Lubumbashi and Abidjan. The studies included retrospective mortality surveys and nested anti-SARS-CoV-2 antibody prevalence surveys. In Lubumbashi the study took place during April-May 2021 and in Abidjan the survey was implemented in two phases: July-August 2021 and October-November 2021. Crude mortality rates were stratified between pre-pandemic and pandemic periods and further investigated by age group and COVID waves. Anti-SARS-CoV-2 seroprevalence was quantified by rapid diagnostic testing (RDT) and laboratory-based testing (ELISA in Lubumbashi and ECLIA in Abidjan). In Lubumbashi, the crude mortality rate (CMR) increased from 0.08 deaths per 10 000 persons per day (pre-pandemic) to 0.20 deaths per 10 000 persons per day (pandemic period). Increases were particularly pronounced among <5 years old. In Abidjan, no overall increase was observed during the pandemic period (pre-pandemic: 0.05 deaths per 10 000 persons per day; pandemic: 0.07 deaths per 10 000 persons per day). However, an increase was observed during the third wave (0.11 deaths per 10 000 persons per day). The estimated seroprevalence in Lubumbashi was 15.7% (RDT) and 43.2% (laboratory-based). In Abidjan, the estimated seroprevalence was 17.4% (RDT) and 72.9% (laboratory-based) during the first phase of the survey and 38.8% (RDT) and 82.2% (laboratory-based) during the second phase of the survey. Although circulation of SARS-CoV-2 seems to have been extensive in both settings, the public health impact varied. The increases, particularly among the youngest age group, suggest indirect impacts of COVID and the pandemic on population health. The seroprevalence results confirmed substantial underdetection of cases through the national surveillance systems.

Early warning for healthcare acquired infections in neonatal care units in a low-resource setting using routinely collected hospital data: The experience from Haiti, 2014-2018.

In low-resource settings, detection of healthcare-acquired outbreaks in neonatal units relies on astute clinical staff to observe unusual morbidity or mortality from sepsis as microbiological diagnostics are often absent. We aimed to generate reliable (and automated) early warnings for potential clusters of neonatal late onset sepsis using retrospective data that could signal the start of an outbreak in an NCU in Port au Prince, Haiti, using routinely collected data on neonatal admissions. We constructed smoothed time series for late onset sepsis cases, late onset sepsis rates, neonatal care unit (NCU) mortality, maternal admissions, neonatal admissions and neonatal antibiotic consumption. An outbreak was defined as a statistical increase in any of these time series indicators. We created three outbreak alarm classes: 1) thresholds: weeks in which the late onset sepsis cases exceeded four, the late onset sepsis rates exceeded 10% of total NCU admissions and the NCU mortality exceeded 15%; 2) differential: late onset sepsis rates and NCU mortality were double the previous week; and 3) aberration: using the improved Farrington model for late onset sepsis rates and NCU mortality. We validated pairs of alarms by calculating the sensitivity and specificity of the weeks in which each alarm was launched and comparing each alarm to the weeks in which a single GNB positive blood culture was reported from a neonate. The threshold and aberration alarms were the strongest predictors for current and future NCU mortality and current LOS rates (p<0.0002). The aberration alarms were also those with the highest sensitivity, specificity, negative predictive value, and positive predictive value. Without microbiological diagnostics in NCUs in low-resource settings, applying these simple algorithms to routinely collected data show great potential to facilitate early warning for possible healthcare-acquired outbreaks of LOS in neonates. The methods used in this study require validation across other low-resource settings.

Risk factors for adverse outcomes in women with high-risk pregnancy and their neonates, Haiti.

OBJECTIVES: To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes. METHODS: We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services. RESULTS: A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55-6.55) and low birthweight (OR 1.40; 95% CI 1.05-1.86) for women with complicated pregnancies. CONCLUSION: To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.

Risk factors for adverse outcomes in women with high-risk pregnancy and their neonates, Haiti

[ABSTRACT]. Objectives. To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-) eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes. Methods. We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services. Results. A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55–6.55) and low birthweight (OR 1.40; 95% CI 1.05–1.86) for women with complicated pregnancies. Conclusion. To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.

[RESUMEN]. Objetivos. Determinar la prevalencia de la muerte materna, la mortinatalidad y el peso bajo al nacer en mujeres con eclampsia o preeclampsia y embarazos o partos complicados en el Centre de Références des Urgences Obstétricales, un hospital de urgencia obstétrica en Puerto Príncipe (Haití), e identificar los principales factores de riesgo de estos resultados adversos del embarazo. Métodos. Se llevó a cabo un estudio de cohortes retrospectivo con embarazadas ingresadas en el Centre de Références des Urgences Obstétricales entre el año 2013 y el 2018 empleando los registros del hospital. Se investigaron como factores de riesgo el grupo etario, el tipo de embarazo (único o múltiple), el tipo de parto y el uso de los servicios de atención prenatal. Resultados. Se incluyó en el análisis un total de 31 509 mujeres y 24 983 partos. De estos, se documentaron 204 (0,6 %) muertes maternas (648 de cada 100 000 mujeres que dan a luz), 1962 (7,9 %) mortinatos y 11 008 (44,1%) recién nacidos con peso bajo al nacer. De todos los ingresos, 10 991 (34,9 %) fueron mujeres con eclampsia y preeclampsia. La cesárea aumentó significativamente el riesgo de muerte materna en mujeres con un embarazo complicado y mujeres con eclampsia y preeclampsia, si bien redujo el riesgo de mortinatalidad en estas mujeres. No asistir a la atención prenatal se asoció con un riesgo significativamente mayor de mortinatalidad (razón de posibilidades [OR] 4,82; intervalo de confianza [IC] de 95 % 3,55-6,55) y peso bajo al nacer (OR 1,40; IC de 95 % 1,05-1,86) en mujeres con embarazos complicados. Conclusiones. Para prevenir y tratar las complicaciones del embarazo lo antes posible, es crucial asistir a la atención prenatal. Se recomienda mejorar el acceso a servicios de atención prenatal de buena calidad y ofrecerlos de manera gratuita a todas las embarazadas en Haití.

[RESUMO]. Objetivos. Determinar a prevalência de mortalidade materna, natimortos e baixo peso ao nascer em mulheres em pré-eclâmpsia, ou gravidez ou partos com complicações no Centre de Références des Urgences Obstétricales, um hospital de emergência obstétrica em Porto Príncipe, no Haiti, e identificar os principais fatores de risco para esses desfechos adversos na gravidez. Métodos. Realizamos um estudo de coorte retrospectivo de gestantes admitidas no Centre de Références des Urgences Obstétricales entre 2013 e 2018, utilizando os prontuários do hospital. Os fatores de risco estudados foram: faixa etária, tipo de gravidez (feto único ou múltiplo), tipo de parto e uso de serviços de atendimento pré-natal. Resultados. A análise incluiu um total de 31.509 mulheres e 24.983 partos. Entre eles, 204 (0,6%) mortes maternas (648 por 100.000 mulheres que deram à luz), 1.962 (7,9%) natimortos e 11.008 (44,1%) recém-nascidos com baixo peso ao nascer estavam documentados. De todas as internações, 10.991 (34,9%) eram de mulheres em pré-eclâmpsia. Parto cesariana aumentou significativamente o risco de mortalidade materna nas mulheres com complicações na gravidez e com pré-eclâmpsia, mas reduziu o risco de natimorto nessas mulheres. Não fazer acompanhamento pré-natal foi associado a risco significativamente maior de natimorto (razão de chances (OR) 4,82; intervalo de confiança de 95% (IC) 3,55-6,55) e baixo peso ao nascer (OR 1,40; IC de 95% 1,05-1,86) para as mulheres com complicações na gravidez. Conclusões. Para prevenir e tratar as complicações da gravidez o mais precocemente possível, o acompanhamento pré-natal é crucial. Recomenda-se o aprimoramento do acesso a serviços de atendimento pré-natal de qualidade e oferecidos gratuitamente a todas as gestantes do Haiti.