What you need to know about Group B Streptococcus in Pregnancy

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Group B streptococcus (GBS), also known as group B strep, is one of many different bacteria which live inside your body. About a third of us has GBS in our gut without even knowing it. This bacteria is normally found in the vagina and/or rectum of about a quarter of women. If you do, you won’t know it’s there, as GBS doesn’t have any obvious symptoms.

GBS bacteria can be passed from you to your baby during labour but this doesn’t usually cause problems, and most women who carry GBS bacteria have healthy babies. It is thankfully only in rare cases that GBS can cause serious illness and, even more rarely, the loss of a newborn baby.

Though it’s unusual, GBS is the most common cause of severe infection in newborns, particularly in the first week after birth (early onset infection).  If you are carrying GBS, you won’t necessarily know, because there aren’t usually any ill-effects. There is a test available for GBS, but it’s not routinely carried out in pregnancy due to concerns about its reliability.

You may discover that you have GBS by chance, when you have a vaginal swab taken to check for something else. GBS test kits can be bought privately, but many experts don’t recommend these because GBS comes and goes, so a positive test early in your pregnancy doesn’t mean you’ll still have GBS at your baby’s birth and a negative test doesn’t necessarily mean you won’t have GBS at a later stage.
Among babies, there are 2 main types of group B strep disease.

  • Early-onset disease — occurs during the first week of life. The group B strep bacteria are passed from the mother to the baby, most often during labor and birth. Antibiotics given during labor can be very effective at preventing this transmission.
  • Late-onset disease — occurs from the first week through three months of life. This is sometimes due to passing of the bacteria from mother to newborn, but sometimes the bacteria come from another source. For a baby whose mother does not test positive for group B strep, the source of infection for late-onset disease can be hard to figure out and is often unknown.

Early-onset disease used to be the most common type of disease in babies. Today, because of effective early-onset disease prevention, early and late-onset disease occurs at similar low rates.

For early-onset disease, group B strep most commonly causes Sepsis (infection of the blood), Pneumonia (infection in the lungs), and sometimes Meningitis (infection of the fluid and lining around the brain). Similar illnesses are associated with late-onset group B strep disease. Meningitis is more common with late-onset group B strep disease than with early-onset group B strep disease.

For both early and late-onset group B strep disease, and particularly for babies who had meningitis, there may be long-term consequences of the group B strep infection such as deafness and developmental disabilities.

Risk Factors:

Some pregnant women are at higher risk of having a baby with early-onset disease. The factors that increase risk include:

  • Testing positive for group B strep late in the current pregnancy (35-37 weeks gestation)
  • Detecting group B strep in urine during the current pregnancy
  • Delivering early (before 37 weeks gestation)
  • Developing fever during labor
  • Having a long period between water breaking and delivering
  • Having a previous infant with early-onset disease
  • If you carry GBS in your vagina and/or rectum during your pregnancy.

Late-onset disease is more common among babies who are born prematurely (< 37 weeks). This is the strongest risk. Babies whose mothers tested group B strep positive also have a higher risk of late onset disease. The risk factors for late onset disease are not as well understood as for early-onset disease.

Most babies exposed to GBS before or during birth are healthy and suffer no ill-effects.  It isn’t clear why some babies develop an infection, while others don’t. What is clear is that most GBS infections in newborn babies can be prevented.
If you are in a high-risk group, you can have antibiotics via a drip that a doctor or nurse will put in a vein in your arm. This will be either from the start of your labour or from when your waters break, whichever comes first, and until your baby is born.

Caesareans are not recommended as a method of preventing GBS infection in babies. That’s because having a caesarean doesn’t eliminate the risk of GBS being passed on to your baby.  GBS may also cause you to have a uterus infection or urinary tract infection (UTI).

If you have been affected by GBS in a previous pregnancy, or are carrying it in your current pregnancy, talk to your midwife or obstetrician. You can then discuss a birth plan that includes steps to protect your baby from the infection.

If you have GBS in your current pregnancy, a hospital birth will be recommended, so you can have antibiotics if you need them.  Your pregnancy will then be managed so your baby is as protected as possible.

Women who are group B strep positive can breastfeed safely. There are many benefits for both the mother and child. Your baby is not at risk of catching GBS from breastfeeding, so there is no need to change your plans if you intend to breastfeed your baby.

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Gestational Diabetes: What you need to know

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Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby’s health. Between 2 and 10 percent of expectant mothers develop this condition, making it one of the most common health problems of pregnancy.

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Nigeria gets US$500m from the World Bank to improve Maternal and Child Health

world-bank-670In an article written by Ndidi Chukwu for Health Reporters, The World Bank Group’s Board of Executive Directors have approved a US$500 million International Development Association (IDA) credit to significantly improve maternal, child, and nutrition health services for women and children in Nigeria. By improving access to higher quality health services, the new development financing will help Nigeria to achieve its “Saving One Million Lives (SOML) Initiative,” which was launched by the Federal Ministry of Health in October 2012 to save the lives of the more than 900,000 women and children who die every year in Nigeria from largely preventable causes. “Saving One Million Lives is a bold response from the Nigerian government to improve the health of the country’s mothers and children so they can survive illness and thrive.  This, in turn, will also contribute to the social and economic development of Africa’s largest economy,” said Benjamin Loevinsohn, a Lead Health Specialist and Task Team Leader for the new project.

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Dr. Luther-King Fasheun: Improving Maternal Health in Nigeria through Partnership

Embedded image permalinkIt is no longer news that Nigeria is a peculiar country, a nation with huge human and natural resources, and whose diversity of peoples and internal geographies is a blessing. Sadly, it is also not news that the country represents at least 10% of the global maternal mortality burden, with a currently estimated maternal mortality ratio (MMR) of 487 per 100,000 livebirths (as at 2011). However, the well thought-out targets of the Ending Preventable Maternal Mortality (EPMM) Working Group present the country with an unprecedented opportunity to change the tide, improve livelihoods for its women and families, and aim to eliminate preventable maternal mortality within a generation, harnessing the right tools and interventions, at the right scale and quality, as well as building on the success factors in the chase for the Millennium Development Goals (MDGs), including the harnessing of a burgeoning private sector and surging political will for improved health outcomes for women, families, and communities.

Based on the EPMM Working Group targets, the proposed MMR target for Nigeria is ‘less than 100 per 100,000 livebirths by 2035, with country-specific milestones, with the expectation that Nigeria will cross one milestone within every 5 year interval.’ For Nigeria, I humbly recommend that the country-specific 5 year interval milestones be context-driven on a State by State basis, given that Nigeria has 36 States, with one Federal Capital Territory (FCT, Abuja). While the federal government provides strategic guidance and robust supportive frameworks for implementation of reproductive, maternal, newborn and child health (RMNCH) interventions for the entire country, the infrastructural and health systems challenges of Nigeria, as well as the resources available to mitigate these challenges, are mainly State-driven. More so, because of the vast population and heterogeneity of Nigeria, as well as the strategic importance of the country to the attainment of global goals, I wish to strongly recommend that the EPMM Working Group sets State-by-State targets, working in partnership with the Nigerian Federal Ministry of Health, and governments of all the 36+1 States.

A State-by-State framework must not shy away from the interconnectedness of States, and the virtual nature of geographic borders, especially because of the very mobile nature of Nigerian women and families, as well as unavoidably shared natural resources, for example. To this end, there should be significant cooperation and sharing of insightful knowledge, under the leadership of the Federal Ministry of Health, and with the assistance of NGOs, CSOs, bilaterals and multilaterals. In this manner, Nigeria presents a window of opportunity to show the world a model that works to eliminate inequities to the last mile, helping to reach global set goals and targets for maternal mortality ratio (MMR) reduction.

The adoption, last year, of the Maternal Death Review (MDR) surveillance mechanism, at the National Council on Health (NCH) meeting, marked a watershed in the history of Nigeria, as it demonstrated a readiness for evidence-based policy frameworks that will mitigate Nigeria’s huge maternal mortality burden. This policy adoption is being followed through with full vigour. Even more recently, the Presidential Summit on Universal Health Coverage promises a new guiding light for the elimination of inequities and barriers to access to healthcare, especially at the primary healthcare level, where the key to unleashing tremendously scaled-up interventions, to save the lives of mothers and children, exists.

Source: Maternal Health Task Force Blog

Maternal Health in Nigeria: Emerging Priorities through Survey

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“Nigeria’s population is only two percent of the world population, but we contribute about 10 percent of the maternal mortality,” said Oladosu Ojengbede, professor and director of the University of Ibadan’s Center for Population and Reproductive Health

Despite efforts to achieve Millennium Development Goal 5 – reduce the maternal mortality ratio by three-quarters compared to levels in 1990 and achieve universal access to reproductive health – Nigeria has seen only modest improvements to maternal health, said a panel of experts participating in a live videoconference in both Abuja and Washington, DC, on December 17.

Nigeria has seen only modest improvements to maternal health in the last 15 years

The simulcast event was preceded by a day-long policy workshop in Abuja with 40 participants from a wide array of stakeholders, including the ministry of health, development partners, NGOs, traditional leaders, health organizations, and the media.

Results from Nigeria’s most recent National Demographic and Health Survey indicate the maternal mortality ratio stood at 576 per 100,000 live births in 2013, compared to 800 deaths per 100,000 live births in 2003 – a 52 percent decline since 1990. Through roundtable discussions, participants identified five key factors to Nigeria’s maternal mortality that must be addressed to accelerate progress.

Five Central Challenges

The first roundtable, led by Dr. Chris Agboghoroma, secretary general of the Society of Gynaecology and Obstetrics of Nigeria, identified quality of care as a critical area for improvement. “The quality of care in most public and private facilities varies significantly from poor to near excellence,” he said. This inconsistency causes women to lose confidence in health services and leads some to refuse services altogether. To improve quality, said Agboghoroma, Nigeria needs dedicated departments in the ministries of health with motivated staff to enforce standards in training institutions.

The second roundtable focused on the provision of integrated services. Dr. Hadiza Galadanci, an obstetrician and gynecologist consultant, said the lack of skilled health care providers, poor infrastructure, and lack of commodities, like family planning, makes it difficult to provide integrated services for women at health facilities. She called for the full involvement of traditional and religious leaders and a more comprehensive curriculum for health workers. Workers should not only be trained in reproductive health services, family planning, or maternal health as individual specialties; they should be able to treat any woman that walks into a facility with a need, she said.

“The quality of care in most public and private facilities varies significantly from poor to near excellence”

Dr. Adesegun Fatusi, provost at Obademi Awolowo University, spoke for the third roundtable. He identified social determinants – such as poverty, child marriage, home delivery without aid or use of a skilled birth attendant, and cultural or religious opposition to family planning – to be consistent contributors to poor maternal health outcomes. There must be macroeconomic, “pro-poor” policies within the health sector that specifically address the poverty rate and provide social protection for the most vulnerable, he said. In addition, stronger legal provisions that protect against child marriage, engaging community leaders, and prioritizing education within households and throughout communities, especially for girls, is required to change social norms, said Fatusi.

The fourth roundtable focused on knowledge gaps and research needs. Efficient data collection, reporting, and funding allows for the interpreting of maternal health trends and translation into policy, said Dr. Oluwadamilola O. Olagun, a project manager with theWhite Ribbon Alliance. In Nigeria, an estimated 38 percent of deliveries take place in health facilities, which means over 60 percent take place outside a facility. A mechanism for collecting maternal health data from all delivery points is therefore essential, she said.

Often, there is also a disconnect between research findings and implementation, which delays progress. More government involvement is needed in research projects and the benefits of these findings need to be better articulated to the government, said Olagun.

Ojengbede spoke for the fifth roundtable, which focused on policy. For maternal health policies in Nigeria to be more successful and sustainable they require political commitment and incorporation into legal frameworks, said Ojengbede. The ministries of justice, health, and civil service organizations working on maternal and child health play an important role. They must support legislation on the state and national levels to ensure accountability and implementation, he said, rather than relying on ad hoc efforts led by third parties.

“Fertilizers to Improve the Fruits of Our Labor”

“It is evident that Nigeria does not lack expertise or insightful discussions,” said John Townsend, vice president and director of reproductive health at Population Council, serving as a discussant in Washington, DC. “However, the issue of moving intervention to scale and getting services to people still needs to be addressed.”

The perception of maternal health must be changed

The importance of execution was well noted by workshop participants. Galadanci called for more comparative research that shows which programs are working in different states to determine which should be expanded. Ojengbede pointed out that Nigeria’s response to the Ebola crisis was very efficient; it created a national sense of emergency which spread awareness quickly. Likewise, the perception of maternal health must be changed so improving conditions for women and children is seen as a national duty for all.

Ojengbede expressed optimism about the outcome of the workshop and Nigeria’s ability to tackle these important issues. “The government and fellow participants both 100 percent agree that the recommendations from this dialogue will be applied like fertilizers to improve and increase the fruits of our labor,” he said.

Dr. Wapada Balami, director of the family health department in the Federal Ministry of Health, said the recommendations would be forwarded to the Honorable Minister of Health, who will set up a committee to advise him on the meeting’s results. “This will help in shaping reproductive, maternal, and newborn health policies in the country.”

Source: New Security Beat