Prevalence of group B streptococcus anogenital colonization and feasibility of an intrapartum screening and antibiotic prophylaxis protocol in Cameroon, Africa

Akila Subramaniam, Christina T. Blanchard, Ekongefeyin Sintieh Nchinda Ngek, Rahel Mbah, Edith Welty, Thomas K. Welty, Jodie Dionne‐Odom, Melissa Sander, Gregory Halle‐Ekane, Alan Tita, the Cameroon Health Initiative · International Journal of Gynecology and Obstetrics

Objective

To evaluate group B streptococcus (GBS) colonization prevalence and feasibility of intrapartum GBS screening/antibiotic prophylaxis (IAP) in Cameroon, Africa.

Methods

Prospective cohort in the Cameroon Baptist Convention Health Services network. Maternity providers collected anogenital swabs from consenting term women in labor for testing by a rapid GBS-polymerase chain reaction (PCR) system. Positive tests (GBS+) resulted in initiation of intravenous ampicillin until delivery. Primary outcomes were GBS prevalence and proportion of GBS+ women receiving ampicillin before delivery and more than 4 hours before delivery.

Results

A total of 219 women were enrolled from January 10 to April 27, 2017. GBS prevalence was 12.3% (95% confidence interval [CI] 7.9-16.7) with GBS+ women more likely to reside in urban areas (19.6% vs 9.7%, P=0.004). Of 27 GBS+ women, 19 (70.4%) received ampicillin before delivery and 14 (51.9%) 4 hours or longer before delivery. A median two doses of ampicillin (interquartile range [IQR] 1-5) were given and started at a median of 105 minutes (IQR 90-155) after swab collection and 20 minutes (IQR 10-45) after GBS result. Of the 8 women who did not receive ampicillin, 7 (87.5%) delivered before test results.

Conclusion

A GBS IAP protocol is feasible in Cameroon and should be evaluated for widespread implementation in Cameroon and other low-income countries to decrease GBS-related morbidity.