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Mndala, Leonard, Monk, Edward J M, Phiri, Deborah, Riches, Jennifer, Makuluni, Regina, Gadama, Luis, Kachale, Fannie, Bilesi, Rosemary, Mbewe, Malangizo, Likaka, Andrew, Chapuma, Chikondi, Kumwenda, Moses, Maseko, Bertha, Ndamala, Chifundo, Kuyere, Annie, Munthali, Laura, Henrion, Marc, Masesa, Clemens and Lissauer, David (2022) 'Comparison of maternal and neonatal outcomes of COVID-19 before and after SARS-CoV-2 omicron emergence in maternity facilities in Malawi (MATSurvey): data from a national maternal surveillance platform.'. Lancet Global Health, Vol 10, Issue 11, e1623-e1631.
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Abstract
Background
Outcomes of omicron-associated COVID-19 in pregnancy have not been reported from low-resource settings, and data from sub-Saharan Africa before the emergence of omicron are scarce. Using a national maternal surveillance platform (MATSurvey), we aimed to compare maternal and neonatal outcomes of COVID-19 in Malawi during the omicron wave to the preceding waves of beta and delta.
Methods
All pregnant and recently pregnant patients, up to 42 days following delivery, admitted to 33 health-care facilities throughout Malawi with symptomatic, test-proven COVID-19 during the second (beta [B.1.351]: January to April, 2021), third (delta [B.1.617.2]: June to October, 2021), and fourth (omicron [B.1.1.529]: December 2021 to March, 2022) waves were included, with no age restrictions. Demographic and clinical features, maternal outcomes of interest (severe maternal outcome [a composite of maternal near-miss events and maternal deaths] and maternal death), and neonatal outcomes of interest (stillbirth and death during maternal stay in the health-care facility of enrolment) were compared between the fourth wave and the second and third waves using Fisher's exact test. Adjusted odds ratios (ORs) for maternal outcomes were estimated using mixed-effects logistic regression.
Findings
Between Jan 1, 2021, and March 31, 2022, 437 patients admitted to 28 health-care facilities conducting MATSurvey had symptoms of COVID-19. SARS-CoV-2 infection was confirmed in 261 patients; of whom 76 (29%) had a severe maternal outcome and 45 (17%) died. These two outcomes were less common during the fourth wave (omicron dominance) than the second wave (adjusted OR of severe maternal outcome: 3·96 [95% CI 1·22–12·83], p=0·022; adjusted OR of maternal death: 5·65 [1·54–20·69], p=0·0090) and the third wave (adjusted OR: 3·18 [1·03–9·80], p=0·044; adjusted OR: 3·52 [0·98–12·60], p=0·053). Shortness of breath was the only symptom associated with poor maternal outcomes of interest (p<0·0001), and was less frequently reported in the fourth wave (23%) than in the second wave (51%; p=0·0007) or third wave (50%; p=0·0004). The demographic characteristics and medical histories of patients were similar across the three waves. During the second and third waves, 12 (13%) of 92 singleton neonates were stillborn or died during maternal stay in the health-care facility of enrolment, compared with 0 of the 25 born in the fourth wave (p=0·067 vs preceding waves combined).
Interpretation
Maternal and neonatal outcomes from COVID-19 were less severe during the fourth wave of the SARS-CoV-2 pandemic in Malawi, during omicron dominance, than during the preceding beta and delta waves.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Administration and Organization > WA 540 National and state health administration WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19 WQ Obstetrics > WQ 20 Research (General) WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology |
| Faculty: Department: | Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/S2214-109X(22)00359-X |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 10 Nov 2022 14:10 |
| Last Modified: | 14 Jun 2023 11:41 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/21294 |
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