title: Tick-borne relapsing fever and pregnancy outcome in rural Tanzania.
abstract: OBJECTIVE
  To assess the impact of tick-borne relapsing fever (TBRF) on the outcome of pregnancy.
  
  
  METHODS
  Case control study of 137 pregnant women (cases) and 120 non-pregnant women (controls) with TBRF between 1985 and 1995.
  
  
  METHODS
  A rural hospital in Tabora Region, Tanzania.
  
  
  RESULTS
  Risk of birth during the attack of TBRF was 58.0%, with an extremely high perinatal mortality of 436 per 1000 births. The total loss of pregnancies including abortions was 475. per 1000. Case-fatality rate in pregnant women was 1.5%, compared to 1.7% in the non-pregnant women. A Jarisch-Herxheimer reaction was seen in 1.5% of the cases and in 1.7% of controls. Relapse rate was 3.6%, compared to 1.7% in non-pregnant women. Pregnant women with TBRF show higher densities of spirochetes than non-pregnant women (p < 0.001). The risk of delivery during the attack was positively correlated to increasing density of the spirochetemia (p < 0.001) and to gestational age (p < 0.001). Perinatal death was related to low birthweight (p < 0.001) and low gestational age (p < 0.001) and not to degree of spirochetemia.
  
  
  CONCLUSIONS
  The extremely high perinatal mortality rate during an attack asks for prevention and early effective management of TBRF. This is a challenge where access to health services in rural areas of developing countries is hampered by many factors.
authors.affiliation: Ndala Hospital, Tabora, Tanzania.
authors.forename: V H
authors.initials: VH
authors.lastname: Jongen
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: J
authors.initials: J
authors.lastname: Tiems
authors.forename: J
authors.initials: J
authors.lastname: Van Holten
authors.forename: J C
authors.initials: JC
authors.lastname: Wetsteyn
mesh_terms: D000328:Adult; D001899:Borrelia Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D011256:Pregnancy Outcome; D012061:Relapsing Fever / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology