Open AccessTick‐borne relapsing fever and pregnancy outcome in rural Tanzania
Author(s) -
Jongen Vincent H. W. M.,
Roosmalen Jos,
Tiems Johannes,
Holten Jacqueline,
Wetsteyn Jose C. F. M.
Publication year - 1997
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.3109/00016349709024361
Subject(s) - medicine , pregnancy , obstetrics , case fatality rate , tanzania , gestational age , gestation , gynecology , population , pediatrics , environmental health , genetics , environmental science , environmental planning , biology
Objective. To assess the impact of tick‐borne relapsing fever (TBRF) on the outcome of pregnancy. Design. Case control study of 137 pregnant women (cases) and 120 non‐pregnant women (controls) with TBRF between 1985 and 1995. Setting. A rural hospital in Tabora Region, Tanzania. Results. Risk of birth during the attack of TBRF was 58.0%, with an extremely high perinatal mortality of 436 per 1000 births. The total loss of pregnancies including abortions was 475 per 1000. Case‐fatality rate in pregnant women was 1.5%, compared to 1.7% in the nonpregnant women. A Jarisch‐Herxheimer reaction was seen in 1.5% of the cases and in 1.7% of controls. Relapse rate was 3.6%, compared to 1.7% in non‐pregnant women. Pregnant women with TBRF show higher densities of spirochetes than non‐pregnant women ( p <0.001). The risk of delivery during the attack was positively correlated to increasing density of the spirochetemia ( p <0.001) and to gestational age ( p <0.001). Perinatal death was related to low birthweight ( p <0.001) and low gestational age ( p <0.001) and not to degree of spirochetemia. Conclusions. The extremely high perinatal mortality rate during an attack asks for prevention and early effective management of TBRF. This is a challenge where access to health services in rural areas of developing countries is hampered by many factors.