Proposed Study on Prevalence of Mother-Baby Transmission in Selected Infectious Diseases in Yemen [Archives:2000/34/Health]

Prof. Najebah AbdulGhani
Sanaa University
The maternal mortality and morbidity in Yemen is high. The maternal mortality ratio estimated for the year 1990 is about 1,400 per 100,000 live births (UNICEF & WHO 1994). The 1997 YDMCH survey reported that maternal deaths represent 42% of all deaths to women at reproductive age for the ten-year period before the survey. The study on maternal mortality factors revealed that the obstetric indirect causes of maternal deaths constituted 39% of all maternal deaths and hepatitis was the leading cause (Abdulghani, 1994). The study in a hospital in Sanaa City revealed that the prevalence of HvsAg among pregnant women is 15.3% (Abdul-Rahim et al, 1991). These figures indicate that viral hepatitis is a major health problem in Yemen.
The contribution of prenatal transmission to the overall burden of disease is related to the prevalence of HbsAg and HbeAg among pregnant women. Pregnant woman with both HbsAg and HbeAg are positive, 70%-90% of her infant become infected if not given prophylaxis at birth compared to 5%-20% transmission in case of mother with HbsAg-positive and HbeAg-negative.
Data on HIV and syphilis infections is available because it is done during blood donation but almost for men. There is a total lack of information on Clamydia and Toxoplasmosis infection. There is no study done on pregnant women in STDs infection and Rubella as well as the extent of transplacental transmission of these diseases to babies.
Therefore, there is a need to explore the extent of the problem of infectious diseases that could be detected serologically among pregnant women. The infectious diseases which is preferable to be studied are: Hepatitis B,C, E, Rubella, Toxoplasmosis, Syphilis, and HIV infections. These viral infections and syphilis are transmitted through placenta and have profound adverse effects on newborns outcome. It is worth mentioning that two of the global monitoring indicators on reproductive health are: 1) The positive syphillis serology prevalence in pregnant women. 2) HIV prevalence among pregnant women.

Objectives
The ultimate objective of a proposed study on prevalence of mother-baby transmission in selected infectious diseases is to provide guidance to decision makers on specific policies to review the strategies that can be implemented on hepatitis B and rubella vaccinations as well as interventions to reduce maternal and prenatal morbidity and mortality.
On the other hand, the immediate objectives to assess the prevalence of hepatitis B, C & E, Toxoplasmosis, Rubella, Syphillis, HIV and Clambydia among pregnant women. Another immediate objective is to identify the risk of perinatal transmission of these infectious diseases in different areas of Yemen and to explore the prevalence of HbeAg among pregnant women.

Methodology
A cross-sectional design will be used as the methodology for this study. It will be conducted on a sample of 3,000 pregnant women during delivery from 10 hospitals in seven governorates of Yemen. Training will be conducted with hospital personnel to interview patients and process serum samples of pregnant women and their babies during delivery in the selected hospitals. Women will be enrolled from all women having deliveries during the month of October 2000. Women will be interviewed with a standardized questionnaire. Reproductive Health and Family Planning Directorate and its sections in the governorate will oversee activity and ensure that the data forms are completed for all women enrolled in the study.

Laboratory:
As for the laboratory work, a venous blood will be collected from the mothers attending delivery and from the cord of the newborns after delivery. The blood sample will be labeled with a study label that is identical to a label that is placed on the questionnaire form. Serum samples will be centrifuged within 20 minutes after collection of a sample and stored frozen in cryovials for storage until transferred to the Central laboratory in Sanaa for testing. The samples will be tested for the following:
1-Hepatitis B surface antigen (HbsAg) implies the carrier state. Will be done for all mothers and newborns of mothers with HbsAg-positive.
2-Mothers with HbsAg-positive will be tested for:
a) Hepatitis B e antigen (HbeAg) identifies the risk of perinatal transmission.
b) Antibody to Hepatitis B core IgM (anti-HbcAgM) mark present acute viral hepatitis. In order to determine whether an acute attack of hepatitis Anti-HbcIgM (implies ongoing virus B related chronic disease, usually chronic active hepatitis)
c) Anti-HB IgG (indicate presistance of viral infection and offers protection against subsequent infections)
3-Antibody to hepatitis E antigen (anti-HEV IgG) for mothers only
4-Antibody to hepatitis C virus (anti-HCV) for mothers and newborns of mothers with HCV-positive
5-Antibody to Toxoplasmosis include
a) Toxo IgM (detect acute cases) for all mothers and newborns of mothers with Toxo IgM-positive
b) Toxo IgG (detect chronic cases) for mothers with Toxo IgM-negative and newborns of mothers with Toxo IgG-positive
6-Antibody against Treponema spirochates (TpHa) by Microhemoagglutination assay for Treponema pallidum to detect Syphilis for mothers and newborns of mothers with TpHa-positive.
7-Antibody test for Clamydia Trachemaous for mothers only
8-Antibody to HIV 1&2 for mothers and newborns of mothers with HIV-positive
9-Antibody to Rubella include
a) Rubella IgG for mothers (indicate protection)
b) Rubella IgM for mothers with Rubell IgG-negative and newborns of mothers with Rubella IgM-positive (indicate acute stage)

Sample Selection:
The frame for sample selection is all women having delivery in the selected hospitals during October 2000. The hospitals selected are as shown in table 1.

Data Collection:
Data collection instrument:
Interviewers using a structured questionnaire will collect the data. The questionnaire which will be developed comprises questions on:
-Mother and her husband Characteristics
-Reproductive history
-Experience with health services procedures
-Pregnancy outcome for newborn and mother

Data collection personnel:
A 5-person team will conduct the field study in each hospital. The team is consisting of a supervisor (Head of Obstetrics & Gynecology department), two midwives for interview of mothers and collection of blood samples (one during the day and another during the night). Two laboratory specialists for blood centrifugation, freezing and transportation. Each team will accomplish the field work in one moth (October 2000). The studys personnel will get a 2-day training course that will be preformed by the principal investigator and the two coordinators, Head of Central Laboratory and his assistants in Sanaa.

Data entry and analysis:
The data will be coded and entered into the computer and will be analyzed using the SPSS package.
Needs of medical supply for the study on prevalence of mother-=baby transmission of selected infections diseases

a) Diagnostic Kits Reagents: See table 2.
b) Medical Equipment
1- Eppemdprf Tube Centrifuge 1
2- Rack for cryotubes 30 Rack
3- Vaccine Carrier, Storage Ca0, 7-1, 0 L 20 carrier

c) Expandible medical supply
1- Vacutainer Tube plain (7 ml) 6,000 tube
2- Vacutainer needle disposal box 120 box
3- Cryotubes 24,000 tube
4- Plate Microwell U-shape 4,000 plate
5- Hamsaplast injection plaster 40 box
6- Cotton
7- Spirt
8- Gloves 50 box

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