Bara maternity staff clueless about deadly baby infection
Study's 'unexpected' findings show babies' lives are at risk because doctors and nurses don't understand the risk factors
Medical staff at SA’s busiest maternity unit are virtually clueless about a common infection that can endanger the lives of newborns, according to a new study.
Two-thirds of doctors and almost all nurses in the maternity unit at Chris Hani Baragwanath Hospital in Soweto failed to correctly name a single risk factor for group B streptococcal disease in babies.
Reporting the “unexpected” findings in the journal PLOS One, a team of researchers from the Wits University medical school said the level of ignorance they detected “suggest failures of implementation of a risk-based strategy over many years”.
The Chris Hani Baragwanath maternity unit delivered 61‚507 babies between 2014 and 2016‚ of which 1‚338 (2%) died. In 2017, Jack Bloom — the DA health spokesperson in the Gauteng legislature — said more resources would help reduce the number of newborn deaths.
“Staff do their best under the circumstances. They have a good spirit and do what they can under adverse conditions. They are distressed when they get blamed for things that are out of their control,” he said.
Lead researcher Caris Price, from the Wits medical school paediatrics and child health department, said 150 doctors and 88 nurses questioned about the hospital’s approach to group B streptococcal disease, or GBS, had “poor overall knowledge”.
Without the resources to adopt a “universal screening” approach that had reduced GBS in newborns by 90% over two decades in the US, Chris Hani Baragwanath had adopted a risk-based strategy, she said.
This involves administering antibiotics during labour to women with five risk factors: labour before 37 weeks, membranes ruptured for more than 18 hours, fever of more than 38ºC during labour, a previous baby with GBS or cultures positive for GBS.
More than 94% of nurses and 68% of doctors were unable to list any of these factors when they filled in researchers’ questionnaires or took part in focus group discussions.
Only 8% of nurses and 38% of senior doctors knew about the hospital’s strategy for GBS, even though southern and eastern Africa have the world’s highest incidences of the infection. It can be fatal, and is associated with 15% of all infection-related stillbirths.
Price said: “The poor knowledge among the interns and nurses — i.e the primary point-of-care healthcare practitioners — may be a consequence of their seniors’ limited ability to advocate the GBS prevention strategy, possibly due to the high clinical workload.”
Bloom said in 2017 the unit was delivering 1,900 babies a month, but had the capacity to handle only 1,400.
A vaccine for GBS had completed two trials, said Price, and may be simpler and more cost-effective than current strategies.
But antibiotics during labour would still be needed for women who went into labour prematurely or who had not been vaccinated. “It is thus imperative that existing practices be optimised,” she said.