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\begin{document}

\title{Group B Streptococcus Colonisation, Prevalence, Associated Risk Factors
and Antimicrobial Susceptibility Pattern Among Pregnant Women Attending
Antenatal Care at Dschang District Hospital, West Region of Cameroun: A
hospital-based Cross Sectional Study}



\author[1]{Leonard Sama}%
\author[1]{michel Noubom}%
\author[1]{Christelle KENNE }%
\author[1]{Thibau  Tchouangueu}%
\author[1]{omer Ngouateu}%
\author[1]{Albert Atsamoh}%
\author[1]{osein karimo}%
\author[1]{christopher tume}%
\affil[1]{Affiliation not available}%


\vspace{-1em}



  
  \date{May 26, 2024}


\begingroup
\let\center\flushleft
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\endgroup





\selectlanguage{english}
\begin{abstract}
Background: Group B streptococcus (GBS), also name as Streptococcus
agalactiae, is a gram-positive bacterium know for it capacity to
colonises the vaginal and rectal areas of the mother and is a leading
cause of neonatal mortality and morbidity. This study aimed at
determining the prevalence, associated risk factors and antimicrobial
susceptibility of GBS colonization among pregnant women attending
antenatal care at Dschang District Hospital. Methods: This hospital-base
cross-sectional study targeted pregnant women population attending
hospitals for routine prenatal testing using a multistage sampling
method. Pregnant women at 23.46 \selectlanguage{ngerman}± 6.44 weeks gestation completed a
questionnaire and vaginal swabs were obtained for GBS analysis. Data
were analysed using chi-squared (\selectlanguage{greek}χ\selectlanguage{english}2) test or the Fisher's exact test
when appropriate and the multivariable logistic regression models.
Results: The colonisation rate of GBS among pregnant women was 8.69\%.
Induce abortion (odds ratio {[}CI{]} = 3.09, 95\% {[}1.56-6.21{]}),
Spontaneaous abortions (OR= 2.82, 95\% CI 1.14-7.29), Stillborn (OR
{[}CI{]} = 7.75, 95\% {[}2.61-21.71{]}), Fever (OR {[}CI{]} = 0.37, 95\%
{[}0.19-0.71{]}) and anemia (OR {[}CI{]} = 0.22, 95\% {[}0.12-0.43{]})
were found to be influencing factors associated with GBS colonisation.
Conclusion: Our findings suggest that none of the studied factors were
significantly associated with GBS colonisation. Further longitudinal
research is needed to establish the causal relationship and its
biological mechanisms. Keys words: Group B Streptococcus, Prevalence,
Risk Factors, Antimicrobial Susceptibility, Pregnant Women%
\end{abstract}%



\sloppy


\textbf{Group B Streptococcus Colonisation, Prevalence, Associated Risk
Factors and Antimicrobial Susceptibility Pattern Among Pregnant Women
Attending Antenatal Care at Dschang District Hospital, West Region of
Cameroun: A hospital-based Cross Sectional Study}

\textbf{Leonard Fonkeng Sama\textsuperscript{1*}, Michel
Noubom\textsuperscript{2,} Christelle Kenne\textsuperscript{2}, Thibau
Flaurant Tchouangueu\textsuperscript{1}, Omer Bebe
Ngouateu\textsuperscript{3}, Albert Donatien
Atsamo\textsuperscript{3}Ousenu Karimo\textsuperscript{1} and
Christopher Bonglavnyuy Tume\textsuperscript{1,4}}

\textsuperscript{1}Unit of Microbiology and Antimicrobial Substances,
Department of Biochemistry, University of Dschang

\textsuperscript{2}Faculty of Medical and pharmaceutical Sciences,
Department of Microbiology and Immunology, University of Dschang,
Cameroon

\textsuperscript{3}Faculty of Science, Department of Animal Biology and
Physiology, University of Yaound\selectlanguage{ngerman}é I,

\textsuperscript{4}University of Bamenda, Faculty of Science, Department
of Biochemistry, University of Bamenda, Cameroon

*\textbf{Corresponding author:} Leonard Fonkeng Sama:
safole2000@yahoo.fr

Other authors e-mails:

Michel Noubom: michelnoubom@yahoo.fr

Kenne Christelle: michel.noubom@yahoo.fr

Thibau Flaurant Tchouangueu: ttchouangueu@gmail.com

Omer Bebe Ngouateu: ob\_ngouateu@yahoo.fr

Albert Donatien Atsamo: atsamoalbert@yahoo.fr

Ousenu Karimo: ousenukarimo90@gmail.com

Christopher B. Tume: tumechrist@yahoo.com

\textbf{ABSTRACT}

\textbf{Background:} Group B streptococcus (GBS), also name as
Streptococcus agalactiae, is a gram-positive bacterium know for it
capacity to colonises the vaginal and rectal areas of the mother and is
a leading cause of neonatal mortality and morbidity. This study aimed at
determining the prevalence, associated risk factors and antimicrobial
susceptibility of GBS colonization among pregnant women attending
antenatal care at Dschang District Hospital.

\textbf{Methods:} This hospital-base cross-sectional study targeted
pregnant women population attending hospitals for routine prenatal
testing using a multistage sampling method. Pregnant women at 23.46 ±
6.44 weeks gestation completed a questionnaire and vaginal swabs were
obtained for GBS analysis. Data were analysed using chi-squared
(\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}) test or the Fisher's exact test when appropriate
and the multivariable logistic regression models.

\textbf{Results:} The colonisation rate of GBS among pregnant women was
8.69\%. Induce abortion (odds ratio {[}CI{]} \textbf{=} 3.09, 95\%
{[}1.56-6.21{]}), Spontaneaous abortions (OR\textbf{=} 2.82, 95\% CI
1.14-7.29), Stillborn (OR {[}CI{]} \textbf{=} 7.75, 95\%
{[}2.61-21.71{]}), Fever (OR {[}CI{]} = 0.37, 95\% {[}0.19-0.71{]}) and
anemia (OR {[}CI{]} = 0.22, 95\% {[}0.12-0.43{]}) were found to be
influencing factors associated with GBS colonisation.

\textbf{Conclusion} : Our findings suggest that none of the studied
factors were significantly associated with GBS colonisation. Further
longitudinal research is needed to establish the causal relationship and
its biological mechanisms.

\textbf{Keys words:} Group B Streptococcus, Prevalence, Risk Factors,
Antimicrobial Susceptibility, Pregnant Women\selectlanguage{english}
\begin{longtable}[]{@{}l@{}}
\toprule
What's known * Few epidemiologic studies have incorporated
multi-di-mensional risk factors for GBS colonisation in pregnant women
to make factors more clear. * In Cameroon, there is no universal
prenatal screening for vaginal GBS colonisation in pregnant women, and
so far the potential factors associated with GBS colonisation in
pregnant women have not been studied. What's new * This study builds on
previous literature to differentiate factors in demographic
characteristics, obstetric factors, pregnancy history, medication
history and disease history to make exposure more accurate. * We found
that induce abortion, spontaneaous abortions, stillborn, were associated
with higher rates of GBS colonisation, but fever and anemia were
associated with lower rates of colonisation, which provides implications
for primary care.\tabularnewline
\bottomrule
\end{longtable}

\textbf{1. INTRODUCTION}

Group B streptococcus (GBS), also name as Streptococcus agalactiae, is a
gram-positive bacterium know for its capacity to cause infection of the
mother infection, fetus, neonatal sepsis and
meningitis\textsuperscript{1,2}. Early-onset diseases in infants such
like pathogen causes chorioamnionitis \textsuperscript{3}, preterm
birth\textsuperscript{4}, stillbirth \textsuperscript{5},
meningitis\textsuperscript{6} are the results of GBS vertical
transmission from a colonised mother during or just before delivery.
These suggest that, maternal colonisation of the genitourinary tracts by
GBS is the primary risk factor for early-onset diseases causing both
early-onset (\textless{} 7 days of life) and late-onset (7--89 days of
life) neonatal sepsis \textsuperscript{7} but also an important cause of
premature rupture of membranes, advanced abortion, premature birth and a
series of adverse of pregnancy outcomes in women \textsuperscript{8,9}.
According to studies, GBS colonization in pregnant women varies from
place to place and ranged from 2.0\% to 32.0\% \textsuperscript{1},
hence the prevalence of a neighbouring country or continent cannot be
used to estimate the prevalence in our setting. Contradicting prevalence
have been revealed according to specific sites in sub-Saharan
Africa\textsuperscript{10} though according to Chaudhry et al. this
prevalence was found to be 19\% \textsuperscript{11}. In Cameroon, few
studies have been conducted on GBS with variable prevalence from 7.7\%
to 14\% in Yaound\selectlanguage{ngerman}é \textsuperscript{12,13} but in the West Region of
Cameroon, no information exist on GBS. Awareness of GBS prevalence in
specific parts of Cameroon remain an important asset to clinicians, in
decision-making about the need for genital or anogenital GBS screening
of pregnant women attending antenatal clinic while identifying
associated factors. This will should however lead to targeted screening
of high risk pregnant women using minimum resources available, all of
which will hopefully contribute the reduction of cases of neonatal
sepsis caused by GBS infection at Dschang Distric Hospital. Currently in
Cameroon, there is no policy for routine GBS screening of pregnant women
attending antenatal care but also no standardized screening method
despite the high perinatal mortality and no treatment is offered to
those affected. If a policy is formulated and effected, this would
contribute to the prevention of live births who get serious GBS neonatal
infection with increased mortality and morbidity.

This study aimed at determining the prevalence, associated risk factors
and antimicrobial susceptibility of GBS colonization among pregnant
women attending antenatal care at Dschang District Hospital (DDH) which
may provide implications for the development of improved and rational
interventions for GBS infection and disease.

\textbf{2. METHODS}

\textbf{2.1 STUDY DESIGN AND POPULATION}

This hospital-base cross-sectional study was conducted from January to
July 2019 and targeted pregnant women population attending antenatal
routine care at the DDH, known to be the main hospital of the Menoua
division in the West Region of Cameroon, with an estimated 100 monthly.
All women that accepted to participate to this study voluntarily signed
an informed consent form irrelative to the gestation age.

\textbf{2.2 DATA AND SPECIMEN COLLECTION}

Local research trained staff interviewed recruited pregnant women using
a standardized questionnaire to record demographic characteristics,
obstetric factors, medication history or disease history. Specimens
where collected from the lower vagina of pregnant women using sterilised
disposable cotton swabs. Each swab was then immerged into 2--3~ml of the
Brain Heart Infusion Broth (BHIB), placed into the specimen
transportation flask and transported to the lab within 30~min.

\textbf{2.2 BACTERIAL STRAINS}

Collected samples were inoculated into blood agar plates supplemented
with colistin nalidixic acid and incubated for 18-24~h at 37°C in a
candle jar enriched with 5\% Carbon-dioxide. All greyish, smooth, small
and non-pigmented colonies with a visible zone of beta hemolysis
appearing 24~h after incubation were isolated, further incubation and
their reactivity to catalase evaluated. Colonies with a negative
catalase reactivity after further incubation were then isolated and used
for the confirmatory diagnosis using the Pastorex strep kit (BIO-RAD).
Colonies which agglutinated with the GBS latex reagent were considered
positive.

The resulting isolates were then used for antibiotic susceptibility
testing by the Kirby Bauer disc difusion method. The antibiotics was
tested and their respective diameters of inhibitions were measure and
compare to those of the French microbiology society as of 2018 (SFM~;
EUCAST)

\textbf{2.3} \textbf{ANTIMICROBIAL SUSCEPTIBILITY TESTING}

Antimicrobial susceptibility testing was performed according to Clinical
and Laboratory Standard Institute Guidelines (CLSI, 2014) by disk
diffusion \textsuperscript{14}. A suspension of the test organism was
prepared by removing 3-5 colonies from a pure culture plate by
emulsifying in 3 ml of sterile physiological saline and was diluted with
saline until the turbidity of the suspension become matched with
turbidity standard equivalent to 0.5 McFarland and inoculated on
Muller-Hinton agar (MHA, Oxoid, England) with 5\% sheep's blood. After
the excess suspension was removed by gentle rotation of the swab against
the surface of the tube, the swab was then used to distribute the
bacteria evenly over the entire surface of MHA supplemented with 5\%
sheep blood. The inoculated plates were left at room temperature to dry
for 3-5 minutes and a set of 6 antibiotic discs in each plate were
placed with the concentration of penicillin G (10\selectlanguage{greek}µ\selectlanguage{english}g), gentamicin (CN)
(10 \selectlanguage{greek}µ\selectlanguage{english}g), erythromycin (E) (15\selectlanguage{greek}µ\selectlanguage{english}g), clindamycin (DA) (2\selectlanguage{greek}µ\selectlanguage{english}g), tetracyclin
(10 \selectlanguage{greek}µ\selectlanguage{english}g), norfloxacin (10 \selectlanguage{greek}µ\selectlanguage{english}g), Chloramphenicol (C) (30\selectlanguage{greek}µ\selectlanguage{english}g), pristicin (10
\selectlanguage{greek}µ\selectlanguage{english}g), steptomycin (10 \selectlanguage{greek}µ\selectlanguage{english}g), rifampicin (10 \selectlanguage{greek}µ\selectlanguage{english}g) and incubated at 35-37 \selectlanguage{ngerman}°C
with 5\% CO\textsubscript{2} atmosphere by candle jar for 18-24 hours.
The zone of growth inhibition was measured using rulers. The sizes of
the inhibition zones were graded according to the CLSI 2014 and
interpreted as susceptible, intermediate or
resistant\textsuperscript{14} (All of the antibiotics used in the
investigation are product of Oxoid, England and HIMEDIA).

\textbf{2.4 STUDY VARIABLES}

The main outcome variable was GBS colonization, defined as positive
sample culture from the lower vagina duct. Potential interfering factors
were chosen a priori on the basis of literature review, including age
(years), marrietal status (single, married, widow), level of education
(Primary, secondary and high education), income \textbf{(} low, moderate
and hight) occupation \textbf{(} Student,
housewife\textbf{,}femer\textbf{,} business\textbf{,} nurse\textbf{,}
teacher\textbf{,}hustle\textbf{,} other), gestationnal age (in weeks),
parity (number of previous births), induce abortion (yes or no),
spontaneaous abortions (yes, no), stillborn (yes, no), previous surgy
(yes, no)\textbf{,}electropic pregnancy (yes, no), induce labour (yes,
no), PROM (yes, no), Number of prenatal visit, used of contraceptive
(yes, no), Used of antibiotic (yes, no), fever (yes, no)\textbf{,}
diabetic (yes, no), HIV status (yes, no)\textbf{,} heart disease (yes,
no), anemia (yes, no) and UTI during pregnancy (yes, no)

\textbf{2.5 DATA ANALYSIS}

Categorical variables of pregnant women included in this study were
compared using Pearson's chi-squared (\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}) test or
Fisher's exact test when appropriate. Multivariable logistic regression
models were fitted to assess correlations between potential factors and
GBS colonisation and were expressed by odds ratios (ORs) and 95\%
confidence intervals (CIs). The level of statistical significance was
set at p \textless{} 0.05. Satatistical analysis was performed using
Graphpad prism version 8.0.2 sofware.

\textbf{2.6} \textbf{ETHICAL CONSIDERATIONS}

Ethical clearance was obtained from the National Ethical Committee for
Research in charge of Human Health (CNERSH),
N\textsuperscript{o}2019/11/56/CE/CNERSH/SP, Yaound\selectlanguage{ngerman}é Cameroon. Research
authorizations were also obtained from all heads of districts in the
Menoua division. Research authorization was also granted by the
University of Dschang.

\textbf{3. RESULTS}

\textbf{3.1 CHARACTERISTICS OF THE STUDY PARTICIPANTS}

A total of 621 pregnant women accepted to participate in this study and
they all had corresponding both obstetric data and bacteriological
cultures. The mean age (± SD) of the study population was 26.49 ± 5.77
years, and the ages ranged from 16 to 44 years. The mean gestational age
(± SD) was 23.46 ± 6.44 weeks, and the gestational ages ranged from 8 to
36 weeks. The overall prevalence of GBS colonisation among pregnant
women was 8.69\% (54/621).

\textbf{3.2 DEMOGRAPHIC CHARACTERISTICS OF STUDY PARTICIPANTS AND
PREVALENCE OF GBS COLONISATION}

Income was positively associated with GBS colonisation (55.56 for low vs
44.44 for moderate and 0\% for high, p = 0.006) whereas Age category,
Marrietal status, Level of education and occupation were not associated
with GBS colonisation (Table 1).

\textbf{3.3 OBSTETRIC FACTORS OR PREGNANCY HISTORY AND GBS COLONISATION}

Concerning obstetric factors, GBS colonisation was found to be
associated with Parity (44.44\% for none vs 55.56\% for 1-3 and 0.00\%
for above 4, p = 0.006), induce abortion (22.22\% vs 77.78\%, p= 0.003),
Spontaneaous abortions (11.11\% vs 88.89\%, p= 0.0037), Stillborn
(11.11\% vs 88.89\%, p= 0.000) and number of prenatal visit (p= 0.0178)
whereas GBS colonisation was not associated with premature
(p\textgreater{}0.999), surgy (p\textgreater{}0.999), ectopic pregnancy
(p\textgreater{}0.999), Induced labour (p\textgreater{}0.999), PROM
(p\textgreater{}0.999) and use of contraceptive (p= 0.202) (Table 2).

\textbf{3.4 MEDICATION HISTORY OR DISEASE HISTORY AND GBS COLONISATION}

Compared with Fever, women with no fever during pregnancy experienced a
higher rate of GBS colonisation (56.61\% vs 43.39\%, p = 0.002).
Similarly, women with no anemia during pregnancy experienced a higher
rate of GBS colonisation (72.22 \% vs 27.78\%, p\textless{}0.000). But
no significant relation was observed for Diabetic, HIV status, Heart
disease and UTI during pregnancy (Table 3).

\textbf{3.5 RISK FACTORS ASSOCIATED TO GBS COLONISATION USING A
MULTIVARIABLE LOGISTIC REGRESSION MODEL}

The multivariable logistic regression model (Table 4) shows that none of
the factor study is positively associated to with GBS colonisation.

\textbf{3.6 ANTIMICROBIAL SUSCEPTIBILITY TESTING}

Most of the GBS isolates were susceptible to Penecilin G (89\%) and
Norfloxacin (83\%). They were all resistant to Gentamicin and
Clindamycin whereas erythomycin, tetracyclin and chloramphenicol were
found to be resistant at 49\%, 34\% and 35\% respectively. Streptomycin
presented the higher intermediate activity (64\%) folow by Pristinamici
(44\%) and Rifampicin (38\%) (Figure 1).

\textbf{4. DISCUSSION}

Group B streptococcus colonisation among pregnant women commonness
worldwide is highly variable (2.0\%-32.0\%)\textsuperscript{1},
depending on regions. In this study, the prevalence of GBS colonisation
was 8.69\%, which is higher than those reported in previous studies in
other regions of Cameroon; including 4\% in a tertiary hospital
in~Cameroon\textsuperscript{13}, 7.7\% at the Yaoundé Gyneco-obstetric
and Paediatric hospital\textsuperscript{15} and 6,7\% at the Yaoundé
General Hospital\textsuperscript{16}. Variations between regions could
possibly be due to differences in sampling method used, sample size,
population variation and geographical difference. However this result is
simillar to the 8.5\% repported in Ethiopia \textsuperscript{17} but
higher than the 4.9\% reported in a hospital-based study and
implications for primary care Shenzhen, China \textsuperscript{18} and
lower than 19.5\% reported in Amman, Jordan \textsuperscript{19}, 13.7\%
repported by Mekelle, 20.86\% by Hawassa and 19\% by Jimma with overall
all in Ethiopia \textsuperscript{20, 21, 22} and the 28.8\% determined
in Uganda\textsuperscript{23}. These variations between countries could
be due to differences in culture methods, populations investigated,
sample size and sampling sites. For example, the prevalence of GBS
sampled from anogenital was hight in Uganda
(28.8\%)\textsuperscript{23}and sampled from both abdominal skin and ear
canal was high in Italy (62.7\%) and in Gambian (33.7\%)
\textsuperscript{24,25} but the prevalence of GBS sampled only from
skin/mucosal surface was low in Pakistan (8.5\%) and in Greece (6.6\%),
\textsuperscript{26,27}indicating potential differences in GBS
colonisation according to the sites of sample collection. It should be
noted GBS screening is not a standard care for maternal GBS colonisation
during pregnancy and increases the risk of neonatal infection by
vertical transmission\textsuperscript{28}. The susceptibility to
antibiotics has shown that antibiotic prophylaxis could effectively
interrupt vertical transmission of GBS and reduce the incidence of GBS
infections. Therefore, these findings recommend the need for screening
of pregnant women for GBS, so that intrapartum antimicrobial prophylaxis
be offered to all GBS-colonised women.

Studies conducted in Cameroon on GBS colonisation in pregnant women have
focused on assessing the prevalence\textsuperscript{12, 13, 15, 16,
19}but risk factors for GBS colonisation have not been systematically
studied. For example, increasing epidemiological studies have
demonstrated the relationship between obesity and GBS colonisation in
pregnant women \textsuperscript{1, 23}. The impact of sociodemographics
factors on GBS colonisation in pregnant women show the association with
the level of income (p = 0006) with high prevalence (55.56\%) found in
patients with low income. This could be due to personal hygiene and
environmental sanitation difference between low and high-income
settings. The difference may also be related with awareness and
behavioral variation. However, in two studies conducted in Zimbabwe
showed significant association of GBS colonization among rural residents
compared to urban residents\textsuperscript{29}.

The impact of obstetric factors on GBS colonisation in pregnant women is
still uncertain since previous results are
inconsistent\textsuperscript{1}. Several studies revealed no significant
differences in colonisation rates according to ectopic pregnancy, induce
labour, PROM and used of contraceptive\textsuperscript{30, 31, 32, 33,
34} as shown in our results. In some research showed increasing age was
significantly associated with lowering rates of GBS
colonisation\textsuperscript{35,36}. The study from a hospital-based
study and implications for primary care revealed that pregnant women had
a significantly higher colonisation rate\textsuperscript{1}. This
corroborate the current findings, eventhough the association was not
significant with higher rates of colonisation in the multivariable
model. Therefore, these inconsistent results may be influenced by many
different cut-off points of gestational age and various structures of
the model fitted. However, parity, induced abortion, spontaneaous
abortions, stillborn, number of prenatal visits were significantly
associated with rates of colonisation in our research. This result is
comparable to the result determined in pregnant women in northern
India\textsuperscript{37} and also with the study conducted by Dechen TC
et al\textsuperscript{38}.

Disease history is potential risk factors for GBS colonisation in
pregnant women\textsuperscript{39,40}. A study in Korea on pregnant
women revealed that urinary tract infection and vaginitis were
significantly associated with GBS colonisation\textsuperscript{30}.
Another study in Bukavu also found that both urinary tract infections
and HIV seropositivity were associated with higher odds ratios for
vaginal colonisation in pregnant women\textsuperscript{39}. However, our
study found that, HIV seropositivity and UTI during pregnancy were
protective factors for GBS colonisation (OR = 0 and 0.51 successively
for HIV and UTI patients). Similar were also shown from a hospital-based
study and implications for primary \textsuperscript{(1)}. Induced
abortion (odds ratio {[}OR{]} \textbf{=} 3.09, 95\% CI 1.56-6.21),
spontaneaous abortions (OR\textbf{=} 2.82, 95\% CI 1.14-7.29), stillborn
(OR\textbf{=} 7.75, 95\% CI 2.61-21.71), fever (OR= 0.37, 95\% CI
0.19-0.71) and anemia (OR = 0.22, 95\% CI 0.12--0.43).

The potential reasons for these results remain unclear. The underlying
biological mechanism and aetiology for these risk factors associated
with GBS colonisation is still uncertain. Genitourinary GBS colonisation
may occur with respect to hygiene, sexual practice or underlying immune
system polymorphisms that reduce innate ability to eliminate the
organism \textsuperscript{41, 42}. Future study examines women who are
originally negative and then become positive is needed, which may
improve our understanding of the risk factors for colonisation.

Results of antibiotic susceptibility testing revealed that almost all
strains (89\%) were sensitive to all penicillins G tested. However
highest levels of resistance were recorded with gentamicin (100\%) and
clindamycin (100\%). Whereas the higher intermediate activity where
found with streptomicin (64\%), Pristinamici (44\%) and Rifampicin
(38\%). These results showed that beta-lactamines known to be used as
ich constitute the recommended first and second line prophylaxis
regimen\textsuperscript{43} were all active on the isolated strains.
However, Erythromycin which is recommended in case of allergy to
beta-Lactamines was not active on some strains. Similar results were
reported by Shiferawu \emph{et~ al} . in South Ethiopia with 100\%
susceptibility of strains to Penicillin G\textsuperscript{44}.

To our knowledge, it is the largest sample studies on this topic in
Cameroon to date, and this study provides new insights into the
interfering factors associated with GBS colonisation among pregnant
women. However, potential limitations also need to be considered. First,
only the vagina was used as a sampling site, with a consequence of
underestimation of the true prevalence of GBS. However, the latest
system review on pregnant women revealed that there was no significant
difference in GBS colonisation according to sample sites (11\% for both
vaginal and rectal samples, 11\% for vaginal samples, and 8\% for other
samples, P = 0.070) \textsuperscript{44}. Second, the study design is a
cross-sectional, in which both cause and effect are measured at the same
time; therefore, we can only describe associations between influencing
factors and GBS colonisation, not a causal conclusion. The
pathophysiological mechanisms responsible for the observed associations
are unknown, therefore results from this study need to be confirmed in
future longitudinal studies. Finally, although it is one of the large
sample studies in Cameroon, it only represents data from one hospital in
one city. Results from this study need to be verified in future
prospective, national, multihospital and multicenter research.

\textbf{CONCLUSION}

The prevalence of GBS colonisation in pregnant women in this study is
not significantly different to that found elsewhere in Cameroon,
indicating the need for screening of pregnant women for GBS so that
intrapartum antimicrobial prophylaxis can be offered to all GBS-
colonised women. We found that income, gestationnal age, parity, induce
abortion, spontaneaous abortions, spontaneaous abortions, stillborn,
number of prenatal visits, fever and anemia were associated with higher
rates of GBS colonisation, while UTI and HIV were associated with lower
rates of colonisation. However, similar sensitivity to beta lactamines
was shown for strains isolated, currently used as the first and second
line prophylactic regimens. Given that our prevalence was hospital
based, we equally recommend large scale epidemiological studies to be
done in other parts of the country to know the current GBS colonisation
rate irrelevant to guide clinical decision making and public health
policies towards implementation of strategies of prevention.

\textbf{ACKNOWLEDGEMENTS}

We thanked all patients who participated and sacrificed their time and
donated samples for this study. We also particularly thank physicians,
nurses and laboratory scientists whose advice given patients was
rewarding to participate in this study at Dschang District Hospital for
their contributions.

\textbf{AUTHOR CONTRIBUTIONS}

LFS, NM and CBTdesigned the study. CK, KO and ADA performed sampling and
laboratory analysis, TFT and OBN performed statistical analysis. All
authors participated in the write-up and approved the final version of
the manuscript

\textbf{FUNDING}

The authors received no financial support for the research and writing
of this manuscript.

\textbf{COMPETING INTERESTS:} None declared

\textbf{Provenance and peer review}

Not commissioned; externally peer reviewed

\textbf{DATA SHARING STATEMENT}

No additional data are available.

\textbf{AUTHORS INFORMATION}

1. LSF is a PhD in the Department of Biochemistry of the University of
Dschang,

Cameroon.

2. NM is a Lecturer and Head of Department of Microbiology and
Immunology Faculty of Health of the University of Dschang

3. CK is a student in the Department of Microbiology and Immunology
Faculty of Health of the University of Dschang

4. TFT is a PhD in the Department of Biochemistry of the University of
Dschang

5. OBN is a lecturer at Department Animal Biology of the University of
Yaounde

6. OK is a PhD student in the Department of Biochemistry of the
University of Dschang

7. ADA is a lecturer at Department Animal Biology of the University of
Yaounde

8. CBT is an Associate Professor of Immunology and Molecular Biology in
the Department of

Biochemistry of the University of Dschang in Cameroon and Head of
Department of Biochemistry of the University of Bamenda, Cameroun.

Table 1: Relation between demographic characteristics of study
participants and prevalence of GBS colonisation\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
Characteristic\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
GBS colonisation n (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
GBS colonisation n (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
OR (95\% CI)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
p-value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Positive}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Negative}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\selectlanguage{greek}\textbf{χ2}\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Age category [?]20 21-30 31-40 41-50\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3 (5.56) 42 (77.78) 9 (16.67) 0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
60 (10.58) 399 (70.37) 93 (16.40) 15 (2.65)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3.04\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.3856\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Marrietal status Single Married widow\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
23 (42.59) 31 (57.41) 0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
300 (52.91) 258 (45.50) 9 (1.59)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3.368\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.1857\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Level of education Primary secondary high education\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6 (11.11) 33 (61.11) 15 (27.78)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
99 (17.46) 330 (58.20) 138 (24.34)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1.484.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.4762\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Income Low Moderate High\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
30 (55.56) 24 (44.44) 0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
192 (33.86) 372 (65.61) 3 (0.53)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
10.24\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.006\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Occupation Student housewife farmer business nurse teacher hustle
other\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
18 (33.33) 12 (22.22) 7 (12.96) 8 (14.86) 0 3 (5.56) 3 (5.56) 2
(3.70)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
180 (31.75) 135 (23.81) 57 (10.05) 102 (17.99) 12 (2.12) 42 (7.41) 15
(2.65) 24 (4.23)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3.666\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.8173\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 2~: Relation between obstetric factors or pregnancy history and
GBS colonisation\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
Factors\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
GBS colonisation n (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
GBS colonisation n (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
OR (95\% CI)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}2\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
p value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Positive}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Negative}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Gestationnal age (wks) 8 12 16 20 24 28 32 36\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 6 (11.11) 4 (7.41) 14 (25.93) 12 (22.22) 6 (11.11) 12 (22.22) 0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3 (0.53) 30 (5.29) 95 (16.75) 124 (21.87) 105 (18.52) 93 (16.40) 99
(17.46) 18 (3.17)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.003\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Parity 0 (1-3) [?]4\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
24 (44.44) 30 (55.56) 0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
177 (31.22) 312 (55.03) 78 (13.76)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
10.1\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.006\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Induce abortion Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
12 (22.22) 42 (77.78)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
48 (8.47) 519 (91.53)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3.09 (1.56 - 6.21)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.003\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Spontaneaous abortions Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6 (11.11) 48 (88.89)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
24 (4.23) 543 (95.77)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
2.82 (1.14 - 7.29)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.037\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Premature Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6 (1.06) 561 (98.94)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Stillborn Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6 (11.11) 48 (88.89)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
9 (1.19) 558 (98.41)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
7.75 (2.61 - 21.71)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.000\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Surgy Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
9 (1.59) 558 (98.41)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Ectopic pregnancy Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3 (0.53) 564 (99.47)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Induce labour Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6 (1.06) 561 (98.94)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
PROM Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6 (1.06) 561 (98.94)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Number of prenatal visit None 1 2 3 4 5 and more\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 15 (27.78) 12 (22.22) 15 (27.78) 9 (16.67) 3 (5.56)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
42 (7.41) 90 (15.87) 126 (22.22) 138 (24.34) 69 (12.17) 102
(17.99)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
13.67\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.0178\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Used of contraceptive Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
21 (38.89) 33 (61.11)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
273 (48.15) 294 (51.85)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.68 (0.39 - 1.22)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.202\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 3~: Relation between medication history or disease history and GBS
colonisation in pregnant women\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
Factors\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
GBS colonisation n (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
GBS colonisation n (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
OR (95\% CI)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\selectlanguage{greek}χ\selectlanguage{english}2\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
p value\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Positive}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Negative}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Used of antibiotic Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
12 (22.22) 42 (77.78)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
144 (25.40) 423 (74.60)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.84 (0.43 - 1.62)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.742\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Fever Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
12 (22.22) 42 (77.78)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
246 (43.39) 321 (56.61)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.37 (0.19- 0.71)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.002\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Diabetic Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
36 (6.35) 531 (93.65)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
HIV status Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
18 (3.17) 549 (96.83)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Heart disease Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 54 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0 567 (100)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textgreater{}0.999\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Anemia Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
15 (27.78) 39 (72.22)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
360 (63.49) 207 (36.51)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.22 (0.12 - 0.43)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textless{}0.000\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
UTI during pregnancy Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
9 (16.67) 45 (83.33)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
159 (28.04) 408 (71.96)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.51 (0.25 - 1.03)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.078\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 4: Multivariate logistic regression to determine independent
predictors\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
Risk factors & Wald & OR & 95\% CI & 95\% CI & P value\tabularnewline
\midrule
\endhead
Age & 0.000 & 0.0219 & 0 & (+inf) & 0.999\tabularnewline
marital status & 0.000 & 7.203 & 0 & (+inf) & 1\tabularnewline
level of education & 0.000 & 0.000 & 0 & (+inf) & 0.996\tabularnewline
income & 0.000 & 0.000 & 0 & (+inf) & 0.999\tabularnewline
occupation & 0.000 & 0.000 & 0 & (+inf) & 0.993\tabularnewline
gestationnal age & 0.000 & 1.269 & 0 & (+inf) & 1\tabularnewline
Parity (No. of previous births & 0.000 & 0.006 & 0 & (+inf) &
0.999\tabularnewline
Induced abortion & 0.000 & 0.000 & 0 & (+inf) & 0.999\tabularnewline
Spontaneous abortion & 0.000 & 0.000 & 0 & (+inf) & 0.999\tabularnewline
premature & 0.000 & 0.000 & 0 & (+inf) & 1\tabularnewline
stillborn & 0.000 & 2.45E+14 & 0 & (+inf) & 0.999\tabularnewline
surgy & 0.000 & \textgreater{}1e40 & 0 & (+inf) & 0.996\tabularnewline
Ectopic pregnancy & 0.000 & 0.000 & 0 & (+inf) & 0.999\tabularnewline
induce labour & 0.000 & 8.15E+28 & 0 & (+inf) & 0.998\tabularnewline
nombre de visite prenatal & 0.000 & 2.468 & 0 & (+inf) &
1\tabularnewline
used of contraceptive & 0.000 & 9.57E+25 & 0 & (+inf) &
0.989\tabularnewline
used of antibiotics & 0.000 & 1.57E+31 & 0 & (+inf) &
0.998\tabularnewline
fever & 0.000 & 3.93E+35 & 0 & (+inf) & 0.992\tabularnewline
diabetic & 0.000 & \textgreater{}1e40 & 0 & (+inf) &
0.997\tabularnewline
HIV status & 0.000 & 1.41E+32 & 0 & (+inf) & 0.998\tabularnewline
Anaemia & 0.000 & 2.22E+36 & 0 & (+inf) & 0.992\tabularnewline
UTI during pregnancy & 0.000 & 3.02E+39 & 0 & (+inf) &
0.998\tabularnewline
\bottomrule
\end{longtable}

\textbf{Hosted file}

\verb`image1.emf`  available at \url{https://authorea.com/users/396573/articles/509727-group-b-streptococcus-colonisation-prevalence-associated-risk-factors-and-antimicrobial-susceptibility-pattern-among-pregnant-women-attending-antenatal-care-at-dschang-district-hospital-west-region-of-cameroun-a-hospital-based-cross-sectional-study}

Figure 1~: antibiotics susceptibility

\textbf{Figure 1} ~: antibiotics suceptibility

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\selectlanguage{english}
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\end{document}

