Why do our babies die? Wits researcher unravels mystery around stillbirths
As humanity is faced with increasing global emergencies, now more than ever, we must all contribute to solutions: for good, and for the good of all people. In the Wits Impacts For Good podcast series, Eusebius McKaiser engages in conversation with Wits Originators, forward-thinking researchers from Wits University, interrogating problems and seeking robust and impactful solutions, backed by leading research.
Meet Shabir Ahmed Madhi – the Wits professor pioneering the vaccine to prevent stillbirths amongst pregnant women in impoverished communities, who are dependent on public health facilities.
As South Africans, we intuitively think of hospitals as the gold standard of hygiene but, if that was the case – why are the numbers of stillbirths and infant deaths still so high? It would seem that the transmission of bacterial infections in healthcare facilities creates a perfect storm for children dying in birth.
As we’ve learned from Eusebius’ conversation with Michael Lucas, the world is grappling with the ongoing problem of hospital-acquired infections, and for this reason, we have to pose an important question:
Could the fate of babies depend on infection control practices in resource-constrained hospitals in South Africa and, has COVID-19 unmasked a lack of adequate control measures on the part of the public health system?
Spearheading a Wits University-led study in Soweto, Professor Madhi and colleagues identified Chris Hani Baragwanath Academic Hospital as the location to conduct the observational study – a public health facility situated in the heart of a poverty-stricken community with high levels of unemployment. Delivering 60 babies each day, the reality for most pregnant women in Soweto is that they are limited to and dependant on the hospital for all their pre- and postnatal care.
The study aimed to evaluate how effective a technique called Minimally Invasive Tissue Sampling (MITS) was in determining the causes of stillbirths in low- and middle-income countries, with a view to informing the rollout of MITS to affected countries via the Child Health and Mortality Prevention Surveillance Network (CHAMPS).
To determine the underlying factors associated with stillbirths in Soweto, the researchers found that while 20–25% of stillbirths occurred due to maternal medical conditions such as hypertension and diabetes, it also found that invasive bacterial infections were the immediate or underlying cause of death in 57.5% of all neonatal deaths. Overall, 74.4% of infection-related deaths were hospital-acquired, mainly due to multidrug-resistant bacteria.
It's a public health issue which has been largely been ignored because of the lack of adequate infection control practices.Shabir Ahmed Madhi, Professor – University of the Witwatersrand
We don't have strong enough infection control practices in our health facility, which lends itself to excess morbidity and mortality on the part of patients and, also, unfortunately, puts healthcare workers at risk of infection.Shabir Ahmed Madhi, Professor – University of the Witwatersrand
The figures are staggering and, are worsened by the findings of a separate study which investigated the deaths of babies under one month of age, researchers found that – when a child is born premature, the most dangerous thing for that child is to be born in hospital, where they acquire infections.
Results of the Soweto pilot study have shown that MITS can accurately determine the cause of stillbirths in South African women and, its observations around hospital-acquired infection as a cause of stillbirths have underpinned and prompted a re-evaluation and introduction of strategies aimed at improving infection control practices at the hospital.
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