Multicentre evaluation of significant bacteriuria among pregnant women in the cascade of referral healthcare system in North-western Tanzania: Bacterial pathogens, antimicrobial resistance profiles and predictors.

OBJECTIVES: The aim of this multicentre study was to evaluate the magnitude of significant bacteriuria (SB) as well as the implicated bacterial pathogens, antimicrobial resistance (AMR) profiles and risk factors for SB among pregnant women attending different levels of healthcare facilities (HCFs) in Tanzania in order to guide antimicrobial therapy and preventive measures. METHODS: Information on sociodemographic and clinical characteristics, midstream urine culture and antimicrobial susceptibility testing was collected from 1828 pregnant women between March 2016 and May 2017. Data were analysed using STATA v.13.0 software. RESULTS: The prevalence of SB among pregnant women was 17.7% (323/1828; 95% CI 16.0-19.5%), with a predominance of Escherichia coli (164/323; 50.8%), Klebsiella spp. (55/323; 17.0%) and Staphylococcus aureus (28/323; 8.7%). Moreover, 37.5% (121/323) of bacteria were multidrug-resistant [84.3% (102/121) Gram-negative bacteria and 15.7% (19/121) in Gram-positive bacteria; P<0.001]. Third-generation cephalosporin resistance in E. coli, Klebsiella spp. and other Enterobacteriaceae was 13.4%, 21.8% and 27.5%, respectively, and was higher in strains from a tertiary hospital (OR=3.27, 95% CI 1.02-10.49; P=0.046) compared with lower HCFs. Predictors of SB among pregnant women were lack of formal occupation, current hospital admission and presence of co-morbidities. CONCLUSIONS: The prevalence of SB among pregnant women in this study was high (17.7%) and was within the same range reported 10 years ago in a single-centre baseline study. However, there is an increase in AMR in the cascade of referral healthcare system, underscoring the need for health facility level-specific antimicrobial stewardship.

Human Immunodeficiency Virus Seroconversion and Associated Risk Factors among Pregnant Women Delivering at Bugando Medical Center in Mwanza, Tanzania.

BACKGROUND: Routine testing for human immunodeficiency virus (HIV) among pregnant women is done early during antenatal care (ANC) in Tanzania, but retesting for the women found negative is rarely done at term or during delivery. AIM: This study aimed at determining the magnitude and risk factors associated with HIV seroconversion among pregnant women delivering at Bugando Medical Center (BMC). SUBJECTS AND METHODS: This cross-sectional study was conducted from January to March 2013 involving 400 pregnant women who tested HIV negative during ANC. These were re-tested during delivery, and those found positive (and their babies) were given antiretroviral therapy (ART) prophylaxis. All exposed babies were tested by polymerase chain reactions (DNAPCR) at 1 month of age. Sociodemographic and clinical characteristics were collected using a structured questionnaire and patients' files. Data were analyzed using SPSS version 17.0 software. RESULTS: Of 400 pregnant women (mean age 26.4 [5.73] years) enrolled, HIV seroconversion was found in 5.3% (21/400). Upon multivariate logistic regression analysis, polygamous marriage (P < 0.001) and history of syphilis during ANC visit (P < 0.001) were found to be independent predictors of HIV seroconversion among pregnant women delivering at BMC. One of the 21 babies (4.8%) born of HIV seroconverted women was confirmed to be HIV infected. CONCLUSION: The high rate of HIV seroconversion found in this study implies that HIV re-testing should be an enduring exercise. This will allow timely provision of ART prophylaxis to HIV seroconverted women and their exposed babies and thus, prevent mother to child transmission of HIV.