Implementing a risk-based group B streptococcus management protocol in a resource-limited tertiary hospital in Ghana: a pre-post intervention study

<title>Abstract</title> <p> Background Group B Streptococcus (GBS; Streptococcus <italic>agalactiae</italic> ) is a major preventable cause of perinatal morbidity and mortality globally, with the highest burden in sub-Saharan Africa. In Ghana, maternal GBS colonisation prevalence ranges from 19–28%, yet no standardised GBS screening or intrapartum antibiotic prophylaxis (IAP) guidelines exist nationally or at an institutional level. This study implemented and evaluated a risk-based GBS IAP protocol combined with continuing medical education (CME) at Tamale Teaching Hospital (TTH), the principal referral centre for northern Ghana. Methods We conducted a quasi-experimental pre-post intervention study at TTH between May 2023 and January 2024. The intervention (August-October 2023) comprised CME workshops, protocol poster displays in labour wards and antenatal clinics, and email dissemination of the protocol. Two parallel tools were used before and after the intervention: a self-administered clinician questionnaire (n = 46 pre-intervention; n = 45 post-intervention, same cohort with one dropout) and a retrospective medical record review of eligible postpartum women (n = 68 pre-intervention; n = 67 post-intervention). Chi-square or Fisher's exact tests were used for categorical variables; t-tests for continuous variables. Statistical significance was set at P &lt; 0.05. Results Identification of penicillin as first-line IAP increased from 34.8% to 91.1% (P &lt; 0.001) and clindamycin as second-line IAP from 15.2% to 80.0% (P &lt; 0.001). The proportion of clinicians not routinely screening for GBS declined from 97.8% to 60.0% (P &lt; 0.001), with the primary barrier shifting from absence of a protocol (91.3% to 13.3%) to lack of GBS transport media (23.9% to 75.6%). Appropriate IAP antibiotic prescription per protocol increased from 7.4% to 92.4% (P &lt; 0.001), and intravenous administration rose from 10.3% to 92.4% (P &lt; 0.001). Bacteriological swab culture rates increased from 14.7% to 34.3% (P = 0.016) but remained low overall. All GBS isolates were penicillin-sensitive at both time points. Conclusions A low-cost, risk-based GBS IAP protocol combined with CME significantly improved clinician knowledge and IAP prescribing practice at a resource-limited tertiary hospital in northern Ghana. Bacteriological screening remained constrained by lack of transport media, a specific, addressable supply-chain gap. This study provides a replicable model for GBS disease prevention guideline development in similar-low resource settings. </p>