Factors associated with perinatal and neonatal deaths in Sao Tome & Principe: a prospective cohort study.

Background: Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country. Methods: Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value <0.05 was considered statistically significant. Results: The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group (n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18-7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74-10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47-15.93], transfer from another unit [cOR 6.08, 95% CI:1.95-18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68-47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14-1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002-0.162] were found to be protective factors. Conclusion: Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4- to 9-fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.

Adverse birth outcomes and associated factors among newborns delivered in Sao Tome & Principe: A case‒control study.

BACKGROUND: Newborns with one-or-more adverse birth outcomes (ABOs) are at greater risk of mortality or long-term morbidity with health impacts into adulthood. Hence, identifying ABO-associated factors is crucial for devising relevant interventions. For this study, ABOs were defined as prematurity (PTB) for gestational age <37 weeks, low birth weight (LBW) <2.5 kg, macrosomia >4 kg, asphyxia for a 5-minute Apgar score <7, congenital anomalies, and neonatal sepsis. This study aimed to assess factors associated with ABOs among babies delivered at the only hospital of Sao Tome & Principe (STP), a resource-constrained sub-Saharan-Central African country. METHODS: A hospital-based unmatched case‒control study was conducted among newborns from randomly selected mothers. Newborns with one-or-more ABO were the cases (ABO group), while healthy newborns were the controls (no-ABO group). Data were collected by a face-to-face interview and abstracted from antenatal care (ANC) pregnancy cards and medical records. Multivariable logistic regression analysis was performed to identify ABO-associated factors considering a level of significance of α = 0.05. RESULTS: A total of 519 newborns (176 with ABO and 343 no-ABO) were enrolled. The mean gestational age and birthweight of cases and controls were 36 (SD = 3.7) weeks with 2659 (SD = 881.44) g and 39.6 (SD = 1.0) weeks with 3256 (SD = 345.83) g, respectively. In the multivariable analysis, twin pregnancy [aOR 4.92, 95% CI 2.25-10.74], prolonged rupture of membranes [aOR 3.43, 95% CI 1.69-6.95], and meconium- fluid [aOR 1.59, 95% CI 0.97-2.62] were significantly associated with ABOs. Eight or more ANC contacts were found to be protective [aOR 0.33, 95% CI 0.18-0.60, p<0.001]. CONCLUSION: Modifiable factors were associated with ABOs in this study and should be considered in cost-effective interventions. The provision of high-quality ANC should be a priority. Twin pregnancies and intrapartum factors such as prolonged rupture of membranes and meconium-stained amniotic fluid are red flags for ABOs that should receive prompt intervention and follow-up.

Determinants of antenatal care utilization - contacts and screenings - in Sao Tome & Principe: a hospital-based cross-sectional study.

BACKGROUND: Sao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion. METHODS: A hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P-value < 0.05. RESULTS: A total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3-52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5-56.7). Age 20-34 [AOR 2.27 (95% CI: 1.28-4.04), p = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21-5.20), p = 0.013] when comparing with women aged 14-19 years, urban residence [AOR 1.98 (95% CI: 1.28-3.06), p < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6-4.2), p < 0.001] were the determinants of adequate ANC utilization. CONCLUSION: Less than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP.

Intestinal Parasitic Infections, Treatment and Associated Factors among Pregnant Women in Sao Tome and Principe: A Cross-Sectional Study.

Background: Intestinal parasitic infections (IPIs) are a public health problem in developing countries such as Sao Tome and Principe (STP) although the pregnancy burden of IPIs is unknown in this endemic country. Thus, the aim of this study was to determine the prevalence of IPIs, prescribed anthelmintics, and associated factors among pregnant women admitted to Hospital Dr. Ayres de Menezes (HAM). Methods: A hospital-based cross-sectional study was conducted among pregnant women admitted to the HAM who had undergone antenatal copro-parasitological screening. Data were abstracted from antenatal care (ANC) cards regarding parasitological results and anthelmintic prescriptions. A structured questionnaire face-to-face interview was also applied. Pregnant women with an IPI (210) were compared to noninfected women (151). Data analysis was performed using SPSS version 25.0. Odds ratios (ORs) with 95% confidence intervals (CIs) for factors associated with IPIs were estimated using multiple logistic regression models. A p value <0.05 was considered statistically significant. Results: A total of 361 participants (210 IPI and 151 no-IPI) with a mean age of 26.96 (SD: 7.00) were included. The overall prevalence of IPI was 58.2% (95% CI 52.9 to 63.3), mainly due to helminthiasis, with a 55.9% (95% CI 50.7-61.2%) rate. Ascaris lumbricoides (90.9%) was the most predominant parasite species identified followed by Trichuris trichiura (13.8%). Polyparasitism was observed in 25 cases (11.9%). Anthelmintics were prescribed to 23% of pregnant women. S intercalatum (11) and E histolytica (7) infections were not adequately treated. IPI was significantly associated with primary education (AOR 1.73 (95% CI: 1.10-2.71)), unemployment (AOR 1.94 (95% CI: 1.20-3.13)), and parity of five or above (AOR 3.82 (95% CI: 1.32-11.08)). Conclusion: This study highlights the IPI burden, associated factors, and missing treatment opportunities among pregnant women with STP. This study is a useful tool for policymakers in STP to enhance the health of women and their unborn babies.

Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?

BACKGROUND: Adolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP. METHODS: An institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran's and Mantel-Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant. RESULTS: The adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18-3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07-5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89-12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes. CONCLUSION: Adolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study.

BACKGROUND: Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents' characteristics and factors associated to early childbearing in STP. METHODS: A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers' clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software. RESULTS: The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2-0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2-0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2-0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn's danger signs (OR 15.7, 95% CI= 9-26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup. CONCLUSIONS: Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents' partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns' danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl's empowerment and awareness and, at the same time, reinforce boy's role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn't, simultaneously, improve educational and economic opportunities for girls.

Bioaccumulation of pesticides and genotoxicity in anurans from southern Brazil.

The expansion of agricultural activities causes habitat loss and fragmentation and the pollution of natural ecosystems through the intense use of pesticides, which may affect the populations of amphibian anurans that inhabit agricultural areas. The present study evaluated the in situ bioaccumulation of pesticides in a population of Leptodactylus luctator that occupies farmland in southern Brazil. We also compared the genotoxicity of L. luctator populations from farmland and forested areas in the same region. We analyzed the micronuclei and nuclear abnormalities of 34 adult anurans, 19 from farmland, and 15 from the forested area. We also assessed the presence of 32 pesticides in liver samples obtained from 18 farmland-dwelling anurans, using chromatographic analysis. We recorded significantly higher rates of nuclear abnormalities in the individuals from the farmland, in comparison with the forest. We detected nine pesticides in the liver samples, of which, deltamethrin was the most common and carbosulfan was recorded at the highest concentrations. The bioaccumulation of pesticides and the higher levels of genotoxic damage found in the anurans from agricultural areas, as observed in the present study, represent a major potential problem for the conservation of these vertebrates, including the decline of their populations and the extinction of species.

Antenatal screenings and maternal diagnosis among pregnant women in Sao Tome & Principe-Missed opportunities to improve neonatal health: A hospital-based study.

Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Príncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1-3 (inadequate), 4-7 (adequate), and ≥8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value ≤0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers' mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1-3 ANC contacts, 46.4% (237) had 4-7 and 38.7% (198) ≥8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (p<0.001) for the complete ANC group when compared to other groups. Antenatal problems identified were: 1) bacteriuria (43.2%); 2) maternal anemia (37%); 3) intestinal parasitic infections (59.2%); 4) sickle cell solubility test positive (13%); and 5) a RhD-negative phenotype (5.8%). Missed-ANC treatments were up to 50%. This study reveals a coverage-quality gap in STP since no pregnant woman is left without ANC contact, although most still miss evidence-based screenings with an impact on neonatal outcomes. Strategies such as implementing a total free ANC screening package in STP would enhance maternal diagnosis and prompt treatments.

Effective methods for the determination of triphenyltin residues in surface water and soil samples by high-performance liquid chromatography with tandem mass spectrometry.

Monitoring of triphenyltin (TPhT) in the environment, particularly to control its misuse in agriculture, is of great importance because of its high toxicity. In this work, methods for determination of TPhT residues in surface water and soil samples by liquid chromatography with tandem mass spectrometry (LC-MS/MS) were developed and validated. Different sample volumes and pH and elution solvent types and volumes were evaluated for solid phase extraction (SPE) of TPhT in surface water samples. The optimized conditions were 500 mg sorbent Strata C18-E, 100 mL of the sample, pH adjusted to 9.0 and 1 mL of methanol containing acetic acid as the eluent. For a 10 g soil sample, the extraction was established using a modified QuEChERS method with 10 mL of acidified acetonitrile followed by a clean-up step by dispersive solid phase extraction (dSPE) with C18. A full factorial 23 design of experiments was applied to optimize the sample preparation method for soil samples. Practical method limits of quantification were 0.1 µg L-1 and 10 µg kg-1 for surface water and soil samples, respectively. Satisfactory accuracy, with recoveries from 86 to 107% for surface water and 72 to 87% for soil samples, as well as good precision, with an overall relative standard deviation (RSD) from 3 to 8% was observed. The validated methods were applied to real samples and some residues of TPhT were found, especially in soil samples (30 to 190 mg kg-1), indicating the suitability for routine analysis.

Influence of pesticides and abiotic conditions on biochemical biomarkers in Aegla aff. longirostri (crustacea, anomura): Implications for conservation.

Freshwater ecosystems are constantly threatened by the advance of agricultural activities. Abiotic variables (such as temperature, ammonia, and nitrite) and contaminants (e.g. pesticides) can potentially interact, increasing metabolism and the absorption of toxic substances, which can alter the ability of organisms to establish adequate stress responses. This study aimed to verify which pesticides were most frequently found and in the greatest quantities in low-order streams, and whether the combination of these pesticides with the abiotic variables altered the biological metabolism of aeglids. These freshwater crustaceans are important shredders that inhabit low-order streams and are sensitive to disturbances and/or abrupt environmental variations. The animals were exposed in situ in four streams (reference site and sites 1, 2, and 3). The reference site is a preserved stream with no apparent anthropogenic interference where aeglids still occur, while the other sites no longer exhibit populations of these animals and are influenced by agricultural activities. The exposure was performed bimonthly from November 2017 to September 2018 and lasted 96 h. Measured abiotic data and water samples were collected through all days of exposure. The analyzed biochemical parameters were acetylcholinesterase activity in muscle; and glutathione S-transferase, lipid peroxidation, protein carbonylation, non-protein thiols, antioxidant capacity against peroxides, and reactive oxygen species (ROS) in muscle, gills, and hepatopancreas. We found 24 active principles of pesticides, the most frequently being clomazone, atrazine, and propoxur. Bentazone was present at the highest amounts. The parameters evaluated in this study, including biochemical biomarkers and abiotic factors measured from the water, provided a separation of the months as a function of environmental conditions. There was a difference in activity and biomarker levels throughout the year within the same site and in some months between sites. The greater concentration or variety of pesticides associated with extreme abiotic (very high temperatures) data generated increased oxidative stress, with high levels of protein damage and considerable lipid damage in all tissues, as well as elevation in ROS, even with high levels of antioxidant capacity and non-protein thiols. With these data, we intend to warn about the risks of exposure to these environmental conditions by trying to contribute to the preservation of limnic fauna, especially aeglid crabs, because most species are under some degree of threat.

Assessment of River Water Quality in an Agricultural Region of Brazil Using Biomarkers in a Native Neotropical Fish, Astyanax spp. (Characidae).

Intensive agricultural and livestock activities demand high pesticide use and, consequently, contaminants reach aquatic ecosystems. In the lower Jacuí River, southern Brazil, there is a lack of knowledge about pesticide residues in water samples and the biochemical responses in native fish species. Thus, this study aimed to estimate the influence of pesticide residues and water parameters to biomarker responses in the native fish Astyanax spp. We performed seasonal biomonitoring in 2017 with water samples and fish collections. Biomarkers of oxidative stress, antioxidants, biotransformation, and neurotoxicity were analyzed in fish tissues. Fourteen pesticide residues were detected; they presented correlations with detoxification enzyme and oxidative stress biomarkers. These data indicate that most of variations can be related to the pesticide presence in water indicating high aquatic pollution in this place.

Evaluation of the rotating disk sorptive extraction technique with polymeric sorbent for multiresidue determination of pesticides in water by ultra-high-performance liquid chromatography-tandem mass spectrometry.

The use of pesticides has been associated with the increase of productivity of crops and control of vectors that cause diseases. However, excessive use of these compounds can cause human health and environmental problems, especially regarding to water resources. In this work, a method for multiresidue determination of 62 pesticides in surface water using the rotating disk sorptive extraction (RDSE) technique for sample preparation and ultra-high-performance liquid chromatography with tandem mass spectrometry (UHPLC-MS/MS) for analysis was optimized and validated. The parameters time and rotational disk velocity for the extraction step, types and amounts of sorbents, sample pH, ionic strength, time and velocity of the rotating disk in the desorption step, as well different desorption solvents were evaluated. The best results were obtained using 50mL of sample, acidified at pH 2.0, and 2.5g of sodium chloride. The selected velocity of rotation in the extraction step was 1600rpm for 80min. Inside the disk cavity, a small amount (20mg) of the polymeric sorbent Oasis® HLB was used. The desorption step was performed immerging the disk in 3mL of methanol and rotating the disk at 1600rpm for 60min. Procedural calibration curves showed linearity between 0.05 or 0.1-2µgL-1, with r2>0.99 for all compounds. The method presented practical limit of quantification of 0.05 or 0.1µgL-1 and suitable accuracy and precision, with recoveries from 70.1 to 119.9% and RSD≤20% for the levels 0.05, 0.1, 0.5 and 2µgL-1. The validated method was applied to surface water samples from different river and residues of atrazine, azoxystrobin, clomazone, difenoconazole, epoxiconazole, propoxur, simazine and tebuconazole were found in the range of 0.06-0.35µgL-1. The results indicate that the proposed method is suitable for the determination of pesticide residues in surface water, allowing an easy and simultaneously preparation of several samples with low material consumption.