Screening & Treatment of Maternal Genitourinary Tract Infections in Early Pregnancy to Prevent Preterm Birth in Rural Sylhet, Bangladesh

Background

Approximately half of preterm births are attributable to maternal infections, which are commonly undetected and untreated in low-income settings. Our primary aim is to determine the impact of early pregnancy screening and treatment of maternal genitourinary tract infections on the incidence of preterm live birth in Sylhet, Bangladesh. We will also assess the effect on other adverse pregnancy outcomes, including preterm birth (stillbirth and live birth), late miscarriage, maternal morbidity, and early onset neonatal sepsis.

Methods/Design

We are conducting a cluster randomized controlled trial that will enroll 10,000 pregnant women in Sylhet district in rural northeastern Bangladesh. Twenty-four clusters, each with ~4000 population (120 pregnant women/year) and served by a community health worker (CHW), are randomized to: 1) the control arm, which provides routine antenatal and postnatal home-based care, or 2) the intervention arm, which includes routine antenatal and postnatal home-based care plus screening and treatment of pregnant women between 13 and 19 weeks of gestation for abnormal vaginal flora (AVF) and urinary tract infection (UTI). CHWs conduct monthly pregnancy surveillance, make 2 antenatal and 4 postnatal home visits for all enrolled pregnant women and newborns, and refer mothers or newborns with symptoms of serious illness to the government sub-district hospital. In the intervention clusters, CHWs perform home-based screening of AVF and UTI. Self-collected vaginal swabs are plated on slides, which are Gram stained and Nugent scored. Women with AVF (Nugent score ≥4) are treated with oral clindamycin, rescreened and retreated, if needed, after 3 weeks. Urine culture is performed and UTI treated with nitrofurantoin. Repeat urine culture is performed after 1 week for test of cure. Gestational age is determined by maternal report of last menstrual period at study enrollment using prospectively completed study calendars, and in a subset by early (<20 week) ultrasound. CHWs prospectively collect data on all pregnancy outcomes, maternal and neonatal morbidity and mortality.

Implications/Discussion

Findings will enhance our understanding of the burden of AVF and UTI in rural Bangladesh, the impact of a maternal screening-treatment program for genitourinary tract infections on perinatal health, and help formulate public health recommendations for infection screening in pregnancy in low-resource settings.

Below:  Map of Sylhet District, Bangladesh and unions participating in the Projahnmo MIST trial

Full article at:  http://goo.gl/1YIxkG

By:  Anne CC Lee¹², Mohammad A. Quaiyum³, Luke C. Mullany², Dipak K. Mitra², Alain Labrique², Parvez Ahmed³, Jamal Uddin⁴, Iftekhar Rafiqullah⁴, Sushil DasGupta³, Arif Mahmud², Emilia H. Koumans⁵, Parul Christian², Samir Saha⁴, Abdullah H. Baqui^2* andfor the Projahnmo Study Group

¹Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston 02115, MA, USA

²Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore 21205, MD, USA

³International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka 1212, Bangladesh

⁴Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka 1207, Bangladesh

⁵Center for Disease Control, 1600 Clifton Road, Atlanta 30329, GA, USA

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