Research Article: Knowledge gaps among South African healthcare providers regarding the prevention of neonatal group B streptococcal disease

Date Published: October 5, 2018

Publisher: Public Library of Science

Author(s): Caris A. Price, Lionel Green-Thompson, Vijay G. Mammen, Shabir A. Madhi, Sanjay G. Lala, Ziyaad Dangor, Barbara Madaj.


To evaluate obstetric healthcare provider knowledge regarding the prevention of group B streptococcal disease in South African infants.

Questionnaires exploring knowledge, attitudes and beliefs around group B streptococcal prevention were administered to consenting doctors and maternity nurses in a tertiary academic hospital. Qualitative assessments (focus groups) were undertaken with junior doctors and nurses.

238 participants completed the questionnaire: 150 (63.0%) doctors and 88 (37.0%) nurses. Overall, 22.7% of participants correctly identified the risk-based prevention protocol recommended at this hospital. Most doctors (68.0%) and nurses (94.3%) could not correctly list a single risk factor. A third of doctors did not know the correct antibiotic protocols, and most (80.0%) did not know the recommended timing of antibiotics in relation to delivery. Focus group discussions highlighted the lack of knowledge, awareness and effective implementation of protocols regarding disease prevention.

Our study highlighted knowledge gaps on the risk-based prevention strategy in a setting which has consistently reported among the highest incidence of invasive group B streptococcal disease globally. In these settings, education and prioritization of the risk-based intrapartum antibiotic strategy is warranted, but an alternative vaccine-based strategy may prove more effective in preventing invasive group B streptococcal disease in the long-term.

Partial Text

In neonates and young infants, group B streptococcus (GBS) is a leading cause of sepsis and meningitis globally [1, 2], with the highest incidence reported in Eastern and Southern Africa [3]. Intravenous intrapartum antibiotic prophylaxis (IAP) has reduced the burden of early-onset GBS disease (EOD) in the United States of America (USA) by almost 90% over two decades [4]. Pregnant women with recto-vaginal GBS colonization between 35–37 weeks of gestational age are administered IAP at least four hours prior to delivery (universal screening). An alternate but less effective strategy to screening-based prophylaxis is to provide IAP to women with risk factors associated with subsequent neonatal invasive GBS disease [5].

In the latter half of 2015, we conducted a prospective study in which we administered questionnaires to obstetric HCPs in a large tertiary referral hospital in Johannesburg, South Africa. Although South Africa is classified by the World Bank as an upper-middle income country, it is nuanced by its history of racial segregation with a legacy of vast inequality, including vast health disparities between different racial groups. This hospital serves a mostly Black-African population of low-income earners (


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