Neonatal Sepsis claims the lives of many newborns here in Moshi. A mom that had delivered by cesarean section late one night came back to Mawenzi on postpartum day #5. She told Dr G and I that her baby had died at home on day of life #4. She and her baby boy were discharged on postpartum day #3. Cause of neonatal death is unknown. Perhaps infection, perhaps sudden infant death.

Yet, I have witnessed many newborns admitted for IV antibiotics due to sepsis. Finally, I asked if mothers were tested for common vaginal bacteria called Group B Streptococcus, which babies are exposed to as they pass through the birth canal. Group B Strep (GBS) is a common cause of neonatal sepsis worldwide. In the US, we have instituted universal testing at 35-36 weeks gestational age. Modern medicine has afforded our citizens to benefit from the most accurate testing method available, yet I was informed that GBS testing is not performed here. The treatment is rather simplistic as it involves giving penicillin to GBS positive mothers in labor. The problem is likely at the level of the small health centers that offer prenatal care. In most instances, women have had between 0 and 2 prenatal visits. Prenatal screening that I am able to discern includes HIV (PMTCT), malaria, blood grouping (sometimes), and Syphilis. Screening for gonorrhea, chlamydia and GBS are likely not performed due to the fact that the testing requires advanced culture materials. Rubella and Hepatitis B are not tested. In fact, the doctors and nurses were vaccinated with their first dose in the Hepatitis B series two weeks ago. I was also offered the vaccine and I thankfully declined since I have had the pleasure of completing the series twice, not to mention the 5 other vaccines I was forced to receive before traveling. In any case, I doubt that Hepatitis B immunoglobulin is available for infants born to moms who are seropositive. If my conclusion is correct, then prenatal screening for Hepatitis B is not useful since no treatment can be offered.
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One of the most crucial elements in perinatal care is pregnancy dating. You could say that OBGYNs are pathologically obsessed with determining accurate gestational ages and due dates. Most women are given due dates based on their recollection of their last menstrual period. I must confess that back home I never base any of my clinical decisions on a woman’s proclamation of her last menstrual period. I must have objective evidence in the form of ultrasound measurements. Unfortunately, very few women have had an ultrasound before presenting to the hospital. Therefore, gestational ages are not precise. I had to take 5 slow breaths one morning when I encountered a woman that was 43 weeks. My mind flashed shocked and panicked faces of all OBGYNS back home. The literature has been very clear in demonstrating an increased risk of stillbirth after 42 weeks of gestation. And without second by second fetal monitoring, fetal death could happen at any time.  The woman was measuring a large baby and there was no doubt that the fetus had reached term gestation. She had been there for 4 days awaiting signs of true labor. Dr G asked me if I would agree to an induction of labor. I exclaimed, “yes! Please!” I would graciously place the cytotec myself and even pay for it if needed!