At the end of March, Julita Gil, a medical epidemiologist for LuxOR, visited Castor's maternity clinic in Bangui, Central African Republic, to investigate an outbreak of Klebsiella pneumoniae.
You were at the MSF Castor Maternity, in Central African Republic. What is the role of this maternity and what is its impact on the region?
The humanitarian crisis in Central African Republic is described as a chronic and complex crisis in a context of underdevelopment. In the capital, Bangui, MSF has supported the Castor maternity since 2014. In terms of security, Castor maternity is on a virtual front line that is particularly exposed to intercommunity tensions.
Castor offers complete obstetric and neonatal care, management of sexual violence, prevention of mother-to-child transmission of HIV, family planning, psychosocial and health promotion support.
Castor is the only one that offers free care. Unsurprisingly, it is therefore the most visited maternity in Bangui with an average of 600 deliveries per month.
There are only four maternities offering a Complete Emergency Obstetric and Neonatal Care in Bangui and Castor is the only one that offers free care. Unsurprisingly, it is therefore the most visited maternity in Bangui with an average of 600 deliveries per month.
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An MSF nurse shows a new mother how to feed a premature baby in the neonatal ward. © Borja Ruiz Rodriguez/MSF
You were sent in a mission at the end of March to the maternity of Castor, what was your role in this mission ?
I joined Castor’s team as a medical epidemiologist from LuxOR to support the control of an outbreak of Klebsiella in neonates in the maternity. My role was to investigate the neonates who were suspected and confirmed with this bacterium. We analyzed when, where and how these cases occurred in the maternity, in order to understand why these neonates became infected. We prioritized our interventions to prevent further cases, based on our findings, which included the main risk factors linked to these cases during their hospitalization.
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A mother and her baby leave the MSF Castor maternity hospital in Bangui. © Borja Ruiz Rodriguez/MSF
What is the Klebsiella? And why is it important for the babies that we respond to outbreaks of this bacteria?
Klebsiella pneumoniae is a bacterium which frequently causes outbreaks in neonatal units in both high and low resource settings. As of March, 19 neonates had sepsis (infection in the bloodstream) in Castors, where Klebsiella was confirmed by the laboratory, 4 of them died. The regular antibiotics were not working, because the Klebsiella bacterium has become resistant to them (called ESBL Klebsiella).
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MSF paediatrician, Marie Muller, checks on a newborn baby together with other staff in the neonatal ward. © Borja Ruiz Rodriguez/MSF
In order to combat this outbreak, a comprehensive response was put in place. It included an emergency order of more complex antibiotics, a close clinical management, systematic laboratory exams to detect further cases, strengthening of hygiene and further staff sent to the field to support the outbreak response.
This outbreak has been an opportunity to improve both the hygiene standards of the maternity and the capacity of detecting similar outbreaks from now on.
During April and May, no further cases of Klebsiella have been observed in the maternity. This outbreak has been an opportunity to improve both the hygiene standards of the maternity and the capacity of detecting similar outbreaks from now on.
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A training session organised by MSF for the staff working at the hospital. © Borja Ruiz Rodriguez/MSF
Why are hygiene standards so crucial ?
Once Klebsiella is in the babies and within the hospital environment, the infection can be transmitted, for example, through the contaminated hands of the staff if hygiene standards are not appropriate.
This is an existing problem in European hospitals, but in an overcrowded facility like Castor, it is striking to realize that it is far more challenging to ensure that standards, such as adequate hand hygiene, are in place. Nonetheless, it is our role to increasingly detect and prevent these outbreaks through the improvement of infection prevention and control standards in our facilities, and to improve them in a sustainable way.
* Main picture : portrait of Stella, 22, and her newborn baby. She is using the kangaroo mother care technique, used in the Castor hospital for those babies whose weight is below 1.6kg. © Borja Ruiz Rodriguez/MSF
