Assessing the Prevalence and Significance of Group B Streptococcal Colonization in Pregnant Ugandan Women

Group B Streptococcus (GBS) is a common type of bacteria often carried in the intestines or lower genital tract.  Although GBS is usually harmless in healthy adults, it can cause serious complications during pregnancy and serious illness in newborns. GBS is the leading cause of sepsis, pneumonia and meningitis in newborns. About one in four women who carry GBS remain asymptomatic throughout pregnancy.

During the past decade, major initiatives have been initiated to prevent early-onset infection. The goal of these preventive strategies is to reduce or eliminate transmission of GBS to the neonate by giving antibiotics to women who carry GBS during delivery and selectively administering antibiotics to newborns after delivery. The Centers for Diseases Control and Prevention (CDC) recommend universal screening for GBS between 35 and 37 weeks of pregnancy and in-labor antibiotics for all women who test positive.

While customary in the United States, women in most low-income countries are not currently screened for GBS infections; therefore, neither women who carry GBS nor their newborn infants are treated with potentially life-saving antibiotics at the time of delivery. The frequency of women carrying GBS has been studied in various countries and appears to vary widely across Sub-Saharan Africa, with prevalence rates found as high as 23 percent in Tanzania and as low as 7.2 percent in Ethiopia. However, there is limited information on the country-specific infection rates, precluding the ability to prioritize lifesaving screening and prophylaxis programs. In Uganda, little is known about the prevalence of GBS rates in among pregnant women even though GBS is known to have been a large contributor to neonatal sepsis and infant mortality in the developed world for decades. 

In this pilot study, Edward O’Bryan, M.D., an assistant professor in the MUSC Division of Emergency Medicine, will investigate the prevalence of GBS in pregnant women in northwestern Uganda. Terry Dixon, M.D., Ph.D., assistant professor in the College of Medicine, is a co-investigator who will also be contributing to this study. The team will establish and screen a cohort of patients at Masindi-Kitara Medical Center (MKMC), a regional referral hospital with full labor and delivery, surgical, antenatal, prenatal, pediatric and neonatal service units. MKMC is operated by OneWorld Health, a Charleston-based non-profit organization that was established by O’Bryan, the principal investigator of the study. Vaginal and rectal swabs will be obtained at MKMC, from 100 different pregnant women at 28 weeks of gestation or later. There they will be cultured and tested for GBS. Those with positive results will be provided appropriate antibiotic prophylaxis.

The findings from this study will allow the investigators to evaluate the potential implication of GBS on neonatal sepsis and neonatal mortality and determine if GBS infections among pregnant Ugandan women represent a percentage significant enough to warrant widespread screening and prophylaxis, similar to the strategy currently used in the U.S. The findings also have the potential to provide a strong framework for evaluating other potential causes of neonatal sepsis and maternal health in Uganda.

“We believe that this represents a significant opportunity to reduce neonatal mortality,” said O’Bryan.