Submitted:
29 May 2023
Posted:
07 June 2023
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Abstract
Objectives: Pregnant women represent a population category at high risk of severe rubella infection, capable of adversely affecting their fetus. This study was conducted to determine the seroprevalence of anti-rubella antibodies in pregnant women seen in prenatal consultations at the Sino-Gabonese Friendship Hospital in Franceville
Patients and Methods: A prospective, cross-sectional study was conducted at the Sino-Gabonese Friendship Hospital in Franceville, from April 3 to July 27, 2023. Using a structured and pre-established questionnaire, sociodemographic and obstetrical characteristics were obtained... Three milliliters of blood were collected from participants to measure rubella-specific IgG antibody levels using the OnSite Rapid Test Rubella IgG/IgM COMBO lateral flow immunochromatographic assay. Results were considered significant at p≤0.05.
Results: The study included 107 pregnant women seen in prenatal consultations. With a mean age of 27.9±7.1 years, anti-Rubella IgG antibodies were found in 87 pregnant women, indicating an overall seroprevalence of 81.30% (95% CI: [0.72 - 0.87). Of these, 6.9% (n = 6) of the women were serum anti-Rubivirus IgM carriers. In univariate analysis, it was indicated that pregnant women in the study aged between 21-30 years (OR =0.33; 95% CI: [0.12-0.9] p=0.0027), student (OR =6.35; 95% CI: [1.39-29.09] p=0.001), or without professional status (OR =0.05; 95% CI: [0.01- 0.27] p<0.001), high school education (OR =8.24; 95% CI: [2.83-23.96] p<0.001), single (OR =0.3; 95% CI: [0.11-0.85] p=0.0021) or cohabiting OR =3.91; 95% CI: [1.21-12.64] p=0.0017) Residing in an urban area (OR =49; 95% CI: [1.43-16.75] p=0.006), in the first trimester of their pregnancy (OR = 0.29; 95% CI: [0.09-0.94] p= 0.033), with a history of spontaneous abortion (OR = 0.09; 95% CI: [1.04; 11.30] p= 0. 037), and unvaccinated (OR = 0.13; 95% CI: [0.05; 0.13] p<0.000), had an elevated risk of Rubella, After adjusting for risk factors by logistic regression, residence in a rural area (ORA = 139.87 95% CI : [1.74 -11236.216] p=0.027),and no vaccination (ORA = 43.3 95% CI: [1.13 -1662.7] p= 0.043), were identified as the only significant risk factors for Rubella for the present study population
Conclusion: The high rate of susceptibility to rubella among pregnant women in the present study indicates that any short-term vaccination strategy aimed at reducing the number of susceptible women of childbearing age is imperative
Keywords:
Transmission
; Rubella
; Pregnant women
; Friendship Sino-Gabonese Hospital
; Franceville
; Gabon
I. INTRODUCTION
Nowadays, viral infections are increasingly common worldwide (Morse S et al., 2001). One of these is rubella. Although this disease is benign, it affects both children and adults. It is responsible for numerous intrauterine complications in pregnancy, which can cause a series of malformations of the embryo, death of the fetus, and premature delivery in the case of primary infection in pregnant women (Camejo Leonor M et al., 2023). In the world, the major epidemics of the disease have occurred in developed countries. This is the case of Great Britain in 1940, Sweden in 1951 and the United Kingdom in 2006, Sweden in 1951 and the United States of America in 1964. In developing countries, an epidemic occurred in Panama in the mid-1980s. In the United States alone, more than 20,000 cases of congenital rubella syndrome (CRS) have been reported (Berg AH et al., 2022). As the public health burden of rubella is related to the risk of infection in pregnant women, many countries have developed a vaccine, to eradicate rubella and congenital rubella syndrome (WHO, 2018). This is the case of the USA which, have not reported cases of naturally transmitted rubella since 2004 (Wallin T, et al 1017), and Canada where the average incident rate has decreased from 0.2000 in 98 to 0.0003 in 2011 (Public Health Agency of Canada. 2014) and have conducted serological surveys to determine the proportion of women of childbearing age who are susceptible to rubella. (Kassa ZY et al., 2020). Rubella is a public health problem that results in the birth of approximately 110,000 children with congenital rubella syndrome (CRS) (Duszak, RS et al., 2009). In contrast to these countries, rubella remains a real public health problem in developing countries (countries in Africa, Southeast Asia and the Middle East (Lambert N et al., 2015). Moreover, it is estimated that the magnitude of congenital rubella syndrome for countries without rubella vaccine policy can be very large (Su Q et al.,2021)... For example in 1996, there were nearly 22,000 congenital rubella cases in Africa and nearly 46,000 in Southeast Asia (Masresha B, et al., 2018). Gabon, a central African country is not immune to the antics of this rubella burden. Despite the integration of the Expanded Program on Immunization (EPI) in primary health care centers, the integration of vaccination outside the EPI (Ategbo S, et al., 2010), there are no rubella screening programs in pregnant women but rather a detection of immunity in them, towards the disease. Thus, the magnitude of the problem is unknown. . The lack of data on the seroprevalence of the virus responsible for the disease among pregnant women in this country therefore prompted the setting up of this study, with the general objective of assessing the seroprevalence of rubella virus among pregnant women receiving antenatal care at the Sino-Gabonese Friendship Hospital in Franceville.
II. MATERIALS AND METHODS
II.1 Study setting
The study was conducted in the medical analysis laboratory of the Sino-Gabonese Friendship Hospital in Franceville, the capital of the second province (Haut-Ogooué) of Gabon in terms of population. This city is divided into four districts. Located in the 2nd district, the Sino-Gabonese Friendship Hospital of Franceville is a support hospital for the Amissa Bongo University Hospital of Franceville, another public health structure, and receives patients from all walks of life.
II. 2. Type and period Study population
This is a prospective and cross-sectional study with descriptive and analytical purposes, which was conducted from April 11 to July 2023, and focused on pregnant women who came for prenatal consultation during the study period to the Sino-Gabonese Friendship Hospital in Franceville.
II.3 Inclusion and exclusion criteria
Only pregnant women were included in the study who were undergoing prenatal consultations at the Sino-Gabonese Friendship Hospital and who had consented to participate in the study. Non-pregnant women and pregnant women who refused to participate in the study were excluded.
II.4. Sampling method and sample size
To select the pregnant women seen at the Sino-Gabonese Friendship Hospital from April to July 2023, a systematic, random and simple sampling technique was used, and our study population size was 107 participants.
II.5. Questionnaire
A pre-established and structured questionnaire (see appendix) was submitted to the participants to collect socio-demographic characteristics (age, marital status, professional status, level of education, area of residence), and obstetrical characteristics such as pregnacies number, age of pregnancy, history of spontaneous abortion, stillbirth, and immunization status
II. 6. Definitions
Stillbirth: delivery of a fetus showing no signs of life after 20 completed weeks of gestation.
Fetal death: fetal death in utero after 28 completed weeks of gestation.
Spontaneous abortion: a clinically recognized spontaneous miscarriage prior to 20 weeks gestation.
Previous exposure to rubella virus infection: pregnant women whose blood tests positive for IgG antibodies, thus protective immunity against infection.
Recent rubella virus infection: pregnant women testing positive for IgM antibodies.
II.7 Sample collection and storage
After the participants signed the informed consent form, 5 ml of venous blood was collected aseptically at the HASG laboratory in Franceville from each pregnant woman in one EDTA-coated tube and one dry tube. Each tube was centrifuged at 3000 rpm for 10 min to remove the plasma, which was frozen at -20°C until use.
II. 8. Serological diagnosis of rubella
Using the rapid test: OnSite Rapid Test Rubella IgG/IgM COMBO, the diagnosis of Rubella, was made from 3ml of venous blood sample taken from each study participant and the sera separated by centrifugation were stored at 2°C to 8°C until the day of diagnosis. This diagnostic guidance test used is manufactured in the United States by CTK Biotech, inc, located in California.
Interpretation of the result:
Negative result: If only the C line develops, this indicates that anti-Rubella antibodies are not detected in the sample. The result is negative or non-reactive.
- -
- Positive result: In addition to the presence of the C line, if only the M line develops, the test indicates the presence of anti-Rubella IgM. The result is anti-Rubella IgM positive or reactive and anti-Rubella IgG negative or non-reactive.
In addition to the presence of the C line, if only the G line develops, the test indicates the presence of anti-Rubella IgG. The result is positive or reactive anti-Rubella IgG and negative or non-reactive anti-Rubella IgM.
In addition to the presence of the C line, if the M and G lines develop, the test indicates the presence of both anti-Rubella IgM and IgG. The result is anti-Rubella IgM and IgG positive.
- -
- Invalid Test: If no C line develops, the test is invalid regardless of color development on the test lines (G and M) as indicated below. Repeat the test with a new cassette.
II. 9 Data Quality Assurance
To assess its validity and completeness, a questionnaire was pretested with 5% of the study subjects, prior to the actual data collection. This process was methodically and rigorously followed. To verify the accuracy and completeness of the questionnaire data obtained from each study participant, the data were reviewed immediately. The samples were processed and tested by an experienced laboratory professional and according to the recommendations of the supplier and manufacturer. Sensitivity and specificity were 98% and 97.3%, respectively, for the OnSite Rubella IgG/IgM rapid test.
II. 10 Ethical considerations
The authorization to conduct the study was granted by the hospital administration and the sampling was designed on the basis of the voluntary participation of the pregnant women in the study, after explaining the rationale, benefits, and ensuring the confidentiality of the study, Participation in the study was finalized by written and informed consent of each participant. To maintain anonymity, code numbers were used instead of nominal identifiers.
II. 11. Statistical Analysis of Data
The collected data were entered into a Microsoft Excel 2013 spreadsheet, cleaned, and then analyzed using R software version 4.2.1. To assess the association between rubella seroprevalence and various sociodemographic and obstetric characteristics of pregnant women, univariate and then binary logistic regression analyses were performed. Odds ratios and their 95% confidence intervals were used to measure the strength of the association. The p-values were determined and considered significant when they were less than or equal to 0.05.
III. RESULTS
III.1 Rubella seroprevalence among pregnant women in the study (n = 107).
A total of 107 pregnant women seen for prenatal consultation at the Sino-Gabonese Friendship Hospital met the inclusion criteria and responded to the survey. This indicated a 100% response rate for the present study. With a mean age of 27.9 ±7.1 years for all participants, an overall seroprevalence of 81.30% (95% CI:0.72 - 0.87) (n=87), of specific anti-Rubivirus IgG was revealed in these women. Among the latter, 6.9% (n=6) of the women were serum anti-Rubivirus IgM carriers.
III.2 Seroprevalence of Rubella virus infection according to sociodemographic characteristics of pregnant women in the study (N = 107).
A univariate analysis of rubella seroprevalence according to sociodemographic characteristics of the pregnant study women indicated that, those who were aged between 21-30 years (OR =0.33; 95% CI: [0.12-0.9] p=0.0027), student (OR =6.35; 95% CI: [1.39-29.09] p=0.001), or with no occupational status (OR =0.05; 95% CI: [0.01- 0.27] p<0.001), secondary school education (OR =8.24; 95% CI: [2.83-23.96] p<0.001), single (OR =0.3; 95% CI: [0.11-0.85] p=0.0021), or cohabiting OR =3.91; 95% CI: [1.21-12.64] p=0.0017) and residing in a rural area OR =49; 95% CI: [1.43-16.75] p=0.006) were at high risk for rubella virus infection (Table 1).
III.3. Rubella seroprevalence by obstetric characteristics of pregnant women in the study (N = 107)
A univariate analysis of rubella seroprevalence by obstetric characteristics of the pregnant study women indicated that, unlike risk factors that may be associated with rubella such as stillbirth or gestational age, only pregnant women who were in the first quater of pregnancy (OR = 0.29; 95% CI : [0.09-0.94] p=0.033), with a history of spontaneous abortion (OR = 0.09; 95% CI: [1.04; 11.30] p= 0.037), and unvaccinated (OR = 0.13; 95% CI: [0.05; 0.13] p<0.000), had a very high likelihood of being infected with rubella virus. These risk factors were significantly associated with rubella seroprevalence Table 2.
III-4- Multivariate logistic regression analysis of risk factors associated with rubella seroprevalence among pregnant women (n = 107) in the study.
Finally, the result of the multivariate logistic regression analysis indicated that pregnant women in the study residing in rural areas (Adjusted OR = 139.87 95% CI: [1.74 -11236.216] p=0.027), and unvaccinated (Adjusted OR = 43.3 95% CI: [1.13 -1662.7] p= 0.043), were at higher risk of Rubella than other participants. Table 3.
IV-DISCUSSION
Contrary to the results obtained in previous studies, which noted that none of the sera tested had IgM (haabouni, F. et al., 2012), the majority of studies conducted elsewhere indicate that the detection of IgM is a better indicator to assess the seroprevalence of rubella in pregnant women (Sampedro, A. et al., 2013). This is the case in the present study in which, n = 6 i.e., 6.9% of women carried serum anti-rubella IgM. The presence of IgM, compatible with the existence of a recent and evolving rubella, can be responsible for serious complications on the evolution of the fetus, or even abortions and premature birth. In total, 81.30% (n=87) of pregnant women in our study were seropositive for anti-rubella IgG antibodies indicating a sustained infection in the population and indicating endemicity, in an underpopulated country like Gabon, likely to be controlled by setting up regular monitoring of at-risk pregnancies.This result although lower than that reported elsewhere (93.1%) (Olajide OM et al., 2015), it is close to those obtained in studies in China (83.3%) (Meng Q, et al. 2018), India (83.4 and 82.3%) (Muliyil DE, et al., 2018), (Shanmugasundaram D, et al., 2017), Cameroon (88.6%) (Fokunang CN et al., 2010). However, contrasting lower rates were reported in Western Sudan (65.3%) (Hamdan HZ et al., 2011) and Algeria (68.6%) (Oyinloye SO et al., 2017). This variability of results could be justified not only by the different serological diagnostic methods used in the different studies, but also, by differences that exist in the study sample sizes, geographical and environmental characteristics (climate, rainfall, temperature, soil type, altitude...) and everyday behavioral characteristics, of pregnant women such as education level, hygiene practices and dietary habits (Ang, LW et al., 2022). As noted elsewhere, the majority of IgG antibody-positive pregnant women in the present study indicated either prior rubella or acquired immunity. And thus, they were unlikely to infect their fetus outside of a strong immunosuppressed setting (Kolawole OM et al., 2014). On the other hand, it was shown that in the overall rubella seroprevalence among pregnant women in the study, the proportion of IgM positivity was 6.9%. Higher than that reported in Ethiopia (2.1%) (Tamirat B et al., 2017), This prevalence was consistent with the combined prevalence of recent rubella infection in sub-Saharan Africa (5.1%) (Mirambo MM et al., 2015), as also recently reported in Cameroon (5.5%) (Michel N, et al., 2018). In contrast, the proportion of IgM positivity in the present study ((6.9%), was lower than those reported in Northern Ethiopia (9.5%) (Wondimeneh Y, et al., 2018). This diversity of results in different studies, could be due to the difference in endemicity of rubella virus, variability in sample size of the studies, laboratory methods used, and differences in thresholds of tests used.
The results of the univariate analysis of rubella seroprevalence according to the socio-demographic characteristics of the pregnant women in our study revealed that those who were between 21-30 years of age, student, or without professional status, with a high school education, single or cohabiting, and residing in rural areas, were at high risk of rubella. Contrary to other studies (Ekuma UO et al., 2022), it is noted that women with a low professional status, and single people, probably due to their low income, hygiene practices and eating habits, or living in lower socio-economic conditions, are susceptible to contracting the disease (Ramos-Morcillo AJ et al.,2019). Indeed, as in all cities in Gabon, precisely in Franceville, a semi-urban area, populations tend to eat more and more outside their homes. So, with the resurgence of food shops on the public highway (grilled meats, fruits and vegetables, fermented beverages, cakes ...) and even the water that is served to drink, is of questionable origin, quality and hygiene. It could be predicted that the rate of rubella cases in the coming years could be higher, if measures were not put in place to deal with it. This is perhaps why the Gabonese Food Security Agency (GFSA) has undertaken to launch a campaign with the slogan "Eat Out, Eat Clean" to sensitize street food actors on good hygiene practices (Loïc Ntoutoum; 2019).
In addition, a univariate analysis of rubella prevalence according to obstetrical characteristics of the pregnant women in this study indicated that those who were in the first trimester of pregnancy, had a history of spontaneous abortion, and were unvaccinated, had a very high probability of being infected with the rubella virus. This result is in agreement with a study conducted in Ethiopia that found a higher proportion of IgM positivity in pregnant women who were in their first trimester (Tulu B et al., 2018 ). , in Tanzania (Lulandala L et al., 2017). Unlike some studies that found a significant association between rubella prevalence and urban settings (Jahromi AS et al., 2011), further multivariate logistic regression analysis of variables in the present study, showed that rubella seropositivity was significantly associated with rural residence and non-vaccination. These results, similar to those obtained in a study conducted in Canada (Prevention of Congenital Rubella Syndrome. 1999), can be explained by the fact that rubella vaccine is not always administered to unprotected women after delivery, and not all women are tested during pregnancy. Second, in countries in the sub-Saharan region, populations living in the hinterland do not have sufficient information about the appropriateness of vaccination. And the vaccination status of women in Gabon is not checked regularly. Yet, the elimination of congenital rubella syndrome depends not only on effective vaccination in childhood, but also on identifying and vaccinating unprotected women of childbearing age (Dixon MG et al., 2022)
Study strengths and limitations
Although this study provides preliminary data that can support future research, some limitations are recognized. First, the time frame for this study did not allow for a large enough sample size. Second, the OnSite Rapid Test Rubella IgG/IgM COMBO lateral flow chromatography immunoassay, used for the simultaneous and rapid detection and differentiation of IgG and IgM rubella antibodies, should be complemented by IgG sensitivity, specificity and avidity tests such as ELISA. In addition, the molecular biology method (qPCR), which detects Rubivirus RNA, could strengthen the diagnosis and reflect the true burden of rubella in the study population. Third, because the risk factor assessment was conducted on the basis of self-reports by study participants, the study may suffer from recall bias. Finally, because it was conducted only in a hospital setting, this study may not be representative of the general population.
V. CONCLUSIONS
The present study, which has the strength of being one of the few surveys of its kind on rubella infection in pregnant women in Gabon, and particularly in the province of Haut-Ogooué, has provided a comprehensive understanding of the seroprevalence and risk factors of rubella in pregnant women in Franceville and its surroundings. It established that some pregnant women were still at risk of infection during pregnancy, with potential complications for their fetus in case of congenital rubella. The risk of parasitic transmission to the fetus is higher the later in pregnancy the maternal primary infection with rubella virus occurs, conversely to the clinical signs that are more deleterious to the fetus in case of early maternal infection (Mawson AR et al., 2019). The risk factors revealed in the present study, were residence in rural areas and non-vaccination. To limit this risk of congenital rubella, preventive measures should be taken by health authorities in Gabon. In addition, awareness campaigns on rubella and the modes of contamination among pregnant women, training of health professionals in the diagnosis of prenatal infection, as well as lowering the cost or even providing free laboratory diagnosis should be planned by public health authorities to better prevent and control congenital rubella transmission in Gabon.
Author Contributions
TNM and CSO designed the study; UN and APR performed the laboratory work; all authors performed the statistical analyses, interpretation, contributed to the writing and approved the final version of the manuscript.
Funding
No funding was obtained.
Data Availability Statement
In order to preserve the confidentiality of the participants, all data generated and analyzed during this study are not publicly available. However, they are available from the corresponding author upon reasonable request.
Acknowledgments
The authors would like to thank the General Management of the Sino Gabonese Friendship Hospital in Franceville for allowing this study to be conducted and the laboratory technicians who helped perform the laboratory tests for all the patients in the study. .
Conflicts of Interest
The authors declare that there are no conflicts of interest regarding the publication of this article.
Data sharing statement
No additional data are available.
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Table 1.
Univariate analysis of seroprevalence of rubella virus infection according to sociodemographic characteristics of pregnant women in the study.
Table 1.
Univariate analysis of seroprevalence of rubella virus infection according to sociodemographic characteristics of pregnant women in the study.
| Variables | Rubella seroprevalence % (n/N) | Crude OR, 95% CI | p-value |
|---|---|---|---|
| Age groups of pregnant woman (years) | |||
| ≤20 | 80 (12/15) | 0.91 [0.23–3.58] | 0.89 |
| 21–30 | 70.73 (29/41) | 0 .33 [0.12–0.9] | 0.027* |
| 31–40 | 88.89 (40/45) | 2.55 [0.85–7.63] | 0.09 |
| 41–43 | 100 (6/6) | Référence | - |
| Professional status of the pregnant woman | |||
| Pupil/student | 94.74 (36/38) | 6.35 [1.39–29.09] | 0.001* |
| Small job | 76.92 (10/13) | 0.74 [0.18–2.98] | 0.67 |
| Public official | 81.25 (39/48) | Reference | - |
| Without | 25 (2/8) | 0.05 [0.01–0.27] | < 0.001* |
| Education level of the pregnant woman | |||
| Primary | 92 (23/25) | 3.23 [0.69– 15.02] | 0.12 |
| Secondary | 91.02 (71/78) | 8.24 [2.83–23.95] | < 0.001* |
| University | 75 (3/4) | Reference | - |
| Marital status of pregnant woman | |||
| Single | 72 (36/50) | 0.3 [0.11–0.85] | 0.021* |
| Cohabiting | 81.49 (43/47) | 3.91 [1.21–12.64] | 0.017* |
| Engaged | 8.33 (5/6) | 1.16 [0.13–10.51] | 0.90 |
| Married | 75 (3/4) | Référence | - |
| Residence Area of the pregnant woman | |||
| Franceville (Urban) | 85.10 (80/94) | Référence | - |
| Other (Rural) | 53.85 (7/13) | 4.9 [1.43–16.75] | 0.006* |
*= Significant result, OR = Odds ratio, CI = Confidence interval.
Table 2.
Univariate analysis of Rubella seroprevalence according to obstetric characteristics of pregnant women in the study.
Table 2.
Univariate analysis of Rubella seroprevalence according to obstetric characteristics of pregnant women in the study.
| Variables | Rubella Seroprévalence % (n/N) | Crude OR, 95 % CI | Valeur p-value |
|---|---|---|---|
| Age of pregnancy (Quater) | |||
| 1st Quater | 77.05 (47/61) | 0.29 [0,09–0.94] | 0.033* |
| 2nd Quater | 87.5 (28/32) | 1.9 [0.58–6.21] | 0.28 |
| 3rd Trimestre | 85.71 (12/14) | Reference | - |
| Pregnacies number | |||
| Primigeste | 82.9 (63/76) | 1.41 [0.5–3.96] | 0.51 |
| Multiigeste | 77.42 (24/31) | Reference | - |
| Number of deliveries after 20 weeks of pregnancy | |||
| ≤ 2 | 95.12 (37/41) | Reference | - |
| ≥3 | 72.73 (50/66) | 0.29 [0.09–0.94] | 0.061 |
| History of spontaneous abortion | |||
| Yes | 33.33 (2/6) | 0.09 [0.02– 0.53] | 0.002* |
| No | 82.33 (85/101) | Reference | |
| Stillbirth | |||
| Yes | 80 (4/5) | 0,92 [0.1–0.71] | 0.62 |
| No | 81.37 (83/102) | Reference | - |
| Vaccination status against rubella | |||
| Vaccinated | 90.91 (70/77) | Reference | |
| Not Vaccinated | 56.67 (17/30) | 0.13 [0.05–0.13] | < 0.001* |
*= Significant result, OR = Odds ratio, CI = Confidence interval.
Table 3.
Multivariate logistic regression analysis of risk factors for Rubella seroprevalence among pregnant women (n = 97) in the study.
Table 3.
Multivariate logistic regression analysis of risk factors for Rubella seroprevalence among pregnant women (n = 97) in the study.
| Variables | Rubella séroprévalence % (n/N) | Ajusted OR, 95 %CI | Valeur p |
|---|---|---|---|
| Age groups of pregnant woman (years) | |||
| ≤20 | 80 (12/15) | - | - |
| 21–30 | 70.73 (29/41) | - | - |
| 31–40 | 88.89(40/45) | - | - |
| 41–43 | 100 (6/6) | - | - |
| Professional status of the pregnant woman | |||
| Pupil/student | 94.74 (36/38) | - | - |
| Small job | 76.92 (10/13) | - | - |
| Public official | 81.25 (39/48) | - | - |
| Without | 25 (2/8) | - | - |
| Education level of the pregnant woman | |||
| Primary | 92 (23/25) | - | - |
| Secondary | 91.02 (71/78) | - | - |
| University | 75 (3/4) | - | - |
| Marital status of pregnant woman | |||
| Single | 72 (36/50) | 0.48 [0.02 –11.93] | 0.65 |
| Cohabiting | 81.49 (43/47) | - | - |
| Engaged | 8.33 (5/6) | - | - |
| Married | 75 (3/4) | 1 | - |
| Residence Area of the pregnant woman | |||
| Franceville (Urbain) | 85.10 (80/94) | 1 | - |
| Other (Rurale) | 53.85 (7/13) | 139.87 [1.74 –11236.22] | 0.027* |
| Age of pregnancy (Quater) | |||
| 1st Quater | 77.05 (47/61) | 0.064 [0.02 –2.41] | 0.064 |
| 2nd Quater | 87.5 (28/32) | 0.046 [0.00 –5.00] | 0.2 |
| 3rd Quater | 85.71 (12/14) | 1 | |
| History of spontaneous abortion | |||
| Yes | 33.33 (2/6) | - | - |
| No | 82.33 (85/101) | - | - |
| Vaccination status against rubella | |||
| Vaccinated | 90.91 (70/77) | 1 | |
| Not Vaccinated | 56.67 (17/30) | 43.3 [1.13 –1662.7] | 0.043* |
*= Significant result, ORA = Odd ratio = adjusted odds ratio, CI = Confidence interval.
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