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1. Early evaluation of the ‘STOP SEPSIS!’ WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries

Author

Marian Knight, José Guilherme Cecatti, Thae Maung Maung, Mercedes Bonet, Fernando Althabe, Joao Paulo Souza, Bouchra Assarag, Richard Adanu, Kristien Roelens, Kitty Bloemenkamp, Shevin T Jacob, Vijay Kumar, Jens Langhoff-Roos, Vanessa Brizuela, Rizwana Chaudhri, Griet Vandenberghe, Carla Lionela Trigo Romero, Edgardo Abalos, Adama Baguiya, Bukola Fawole, Pisake Lumbiganon, Meilė Minkauskienė, Ashraf Nabhan, Nafissa Bique Osman, Zahida P Qureshi, Mohammad Iqbal Aman, Bashir Noormal, Virginia Díaz, Marisa Espinoza, Julia Pasquale, Charlotte Leroy, M. Christian Urlyss Agossou, Sourou Goufodji Keke, Christiane Tshabu Aguemon, Víctor Conde Altamirano, Rosalinda Hernández Muñoz, Vincent Batiene, Kadari Cisse, Henri Gautier Ouedraogo, Cheang Kannitha, Lam Phirun, Tung Rathavy, Elie Simo, Pierre-Marie Tebeu, Emah Irene Yakana, Javier Carvajal, María Fernanda Escobar, Paula Fernández, Lotte Berdiin Colmorn, Wilson Mereci, Paola Vélez, Yasser Salah Eldin, Alaa Sultan, Abdulfetah Abdulkadir Abdosh, Alula M. Teklu, Dawit Worku Kassa, Philip Govule, Charles Noora Lwanga, Rigoberto Castro Bustillo, Bredy Lara, Vanita Suri, Sonia Trikha, Irene Cetin, Serena Donati, Carlo Personeni, Guldana Baimussanova, Saule Kabylova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Zahida Qureshi, Raisa Asylbasheva, Aigul Boobekova, Damira Seksenbaeva, Faysal El Kak, Saad Eddine Itani, Sabina Abou Malham, Diana Ramašauskaitė, Owen Chikhwaza, Luis Gadama, Eddie Malunga, Haoua Dembele, Hamadoun Sangho, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Nazarea Herrera Maldonado, Tatiana Cauaus, Ala Curteanu, Victor Petrov, Yadamsuren Buyanjargal, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Zara Jaze, Arlete Mariano, Hla Mya Thway Einda, Khaing Nwe Tin, Tara Gurung, Amir Babu Shrestha, Sangeeta Shrestha, Marcus J. Rijken, Thomas Van DenAkker, María Esther Estrada, Olubukola Adesina, Chris Aimakhu, Saima Hamid, M. Adnan Khan, María del Pilar Huatuco Hernández, Nelly M Zavaleta Pimentel, Maria Lu Andal, Carolina Paula Martin, Zenaida Dy Recidoro, Mihaela Budianu, Lucian Pușcașiu, Léopold Diouf, Dembo Guirassy, Philippe Marc Moreira, Miroslav Borovsky, Ladislav Kovac, Alexandra Kristufkova, Sylvia Cebekhulu, Laura Cornelissen, Priya Soma-Pillay, Vicenç Cararach, Marta López, María José Vidal Benedé, Hemali Jayakody, Kapila Jayaratne, Dhammica Rowel, Mohamed Elsheikh, Wisal Nabag, Sara Omer, Victoria Tsoy, Urunbish Uzakova, Dilrabo Yunusova, Catherine Dunlop, David Lissauer, Aquilino M Pérez, Jhon Roman, Gerardo Vitureira, Dinh Anh Tuan, Luong Ngoc Truong, Nghiem Thi Xuan Hanh, Mugove Madziyire, Thulani Magwali, Stephen Munjanja, Mónica Chamillard, Seni Kouanda, Ruta Nadisauskiene, Linda Bartlett, Fernando Bellissimo-Rodrigues, Sadia Shakoor, Khalid Yunis, Liana Campodónico, Cristina Cuesta, Hugo Gamerro, Daniel Giordano, A Metin Gülmezoglu, Patricia Soledad Apaza Peralta, Carolina C Ribeiro do Valle, William Enrique Arriaga Romero, María Guadalupe Flores Aceituno, Thumwadee Tangsiriwatthana, Thitiporn Siriwachirachai, and Néstor J Pavón Gómez

Subjects
Medicine
Abstract

Objective To evaluate changes in awareness of maternal sepsis among healthcare providers resulting from the WHO Global Maternal Sepsis Study (GLOSS) awareness campaign.Design Independent sample precampaign/postcampaign through online and paper-based surveys available for over 30 days before campaign roll-out (pre) and after study data collection (post). Descriptive statistics were used for campaign recognition and exposure, and odds ratio (OR) and percentage change were calculated for differences in awareness, adjusting for confounders using multivariate logistic regression.Setting and participants Healthcare providers from 398 participating facilities in 46 low, middle and high-income countries.Intervention An awareness campaign to accompany GLOSS launched 3 weeks prior to data collection and lasting the entire study period (28 November 2017 to 15 January 2018) and beyond.Main outcome measures Campaign recognition and exposure, and changes in awareness.Results A total of 2188 surveys were analysed: 1155 at baseline and 1033 at postcampaign. Most survey respondents found the campaign materials helpful (94%), that they helped increase awareness (90%) and that they helped motivate to act differently (88%). There were significant changes with regard to: not having heard of maternal sepsis (−63.4% change, pre-OR/post-OR 0.35, 95% CI 0.18 to 0.68) and perception of confidence in making the right decisions with regard to maternal sepsis identification and management (7.3% change, pre-OR/post-OR 1.44, 95% CI 1.01 to 2.06).Conclusions Awareness raising campaigns can contribute to an increase in having heard of maternal sepsis and an increase in provider perception of confidence in making correct decisions. Offering the information to make accurate and timely decisions while promoting environments that enable self-confidence and support could improve maternal sepsis identification and management.

Published
2020
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2. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Author

Mercedes Bonet, Vanessa Brizuela, Edgardo Abalos, Cristina Cuesta, Adama Baguiya, Mónica Chamillard, Bukola Fawole, Marian Knight, Seni Kouanda, Pisake Lumbiganon, Ashraf Nabhan, Ruta J Nadisauskiene, Abdulfetah Abdulkadir, Richard MK Adanu, Mohammad Iqbal Aman, William E. Arriaga Romero, Bouchra Assarag, Kitty W.M. Bloemenkamp, Aigul Boobekova, Mihaela A. Budianu, Vicenç Cararach, Rigoberto Castro, Sylvia Cebekhulu, José Guilherme Cecatti, Lotte Berdiin Colmorn, Ala Curteanu, Serena Donati, Hla Mya Thway Einda, Yasser Salah El Deen, Faysal El Kak, Mohamed Elsheikh, Maria F Escobar-Vidarte, Marisa Mabel Espinoza, María Ester Estrada, Luis Aaron Gadama, Sourou B Goufodji, Saima Hamid, Rosalinda Hernandez Munoz, Nazarea Herrera Maldonado, Kapila Jayaratne, Saule Kabylova, Alexandra Kristufkova, Vijay Kumar, David Lissauer, Wilson Mereci, Meile Minkauskiene, Philippe Moreira, Stephen Munjanja, Nafissa B. Osman, Henri Gautier Ouedraogo, Aquilino M. Perez, Julia Pasquale, Lucian Puscasiu, Zahida Qureshi, Zenaida Recidoro, Carolina C. Ribeiro-do-Valle, Dhammica Rowel, Hamadoun Sangho, Amir Babu Shrestha, Thitiporn Siriwachirachai, Pierre Marie Tebeu, Khaing Nwe Tin, Dinh Anh Tuan, Rathavy Tung, Griet Vandenberghe, Buyanjargal Yadamsuren, Dilrabo Yunusova, Nelly Zavaleta Pimentel, Bashir Noormal, Virginia Díaz, Charlotte Leroy, Kristien Roelens, M. Christian Urlyss Agossou, Christiane Tshabu Aguemon, Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Vincent Batiene, Kadari Cisse, Kannitha Cheang, Phirun Lam, Elie Simo, Emah Irene Yakana, Javier Carvajal, Paula Fernández, Jens Langhoff-Roos, Paola Vélez, Alaa Sultan, Alula M. Teklu, Dawit Worku, Philip Govule, Charles Noora Lwanga, María Guadalupe Flores Aceituno, Carolina Bustillo, Bredy Lara, Vanita Suri, Sonia Trikha, Irene Cetin, Carlo Personeni, Guldana Baimussanova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Raisa Asylbasheva, Damira Seksenbaeva, Saad Eddine Itani, Sabina Abou Malham, Diana Ramašauskaitė, Owen Chikhwaza, Eddie Malunga, Haoua Dembele, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Juan I. Islas Castañeda, Tatiana Cauaus, Victor Petrov, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Zara Jaze, Arlete Mariano, Thae Maung Maung, Tara Gurung, Sangeeta Shrestha, Marcus J. Rijken, Thomas Van Den Akker, María Esther Estrada, Néstor J. Pavón Gómez, Olubukola Adesina, Chris Aimakhu, Rizwana Chaudhri, M. Adnan Khan, María del Pilar Huatuco Hernández, Maria Lu Andal, Carolina Paula Martin, Léopold Diouf, Dembo Guirassy, Miroslav Borovsky, Ladislav Kovac, Laura Cornelissen, Priya Soma-Pillay, Marta López, María José Vidal Benedé, Hemali Jayakody, Wisal Nabag, Sara Omer, Victoria Tsoy, Urunbish Uzakova, Thumwadee Tangsiriwatthana, Catherine Dunlop, Jhon Roman, Gerardo Vitureira, Luong Ngoc Truong, Nghiem Thi Xuan Hanh, Mugove Madziyire, Thulani Magwali, Linda Bartlett, Fernando Bellissimo-Rodrigues, Shevin T. Jacob, Sadia Shakoor, Khalid Yunis, Liana Campodónico, Hugo Gamerro, Daniel Giordano, Fernando Althabe, A. Metin Gülmezoglu, and João Paulo Souza

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices. Funding: UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.

Published
2020
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3. Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study : a cross-sectional study

Author

Vanessa Brizuela, Cristina Cuesta, Gino Bartolelli, Abdulfetah Abdulkadir Abdosh, Sabina Abou Malham, Bouchra Assarag, Rigoberto Castro Banegas, Virginia Díaz, Faysal El-Kak, Mohamed El Sheikh, Aquilino M Pérez, João Paulo Souza, Mercedes Bonet, Edgardo Abalos, Rigoberto Castro, Faysal El Kak, Mohamed Elsheikh, Aquilino M. Pérez, Mohammad Iqbal Aman, Bashir Noormal, Marisa Espinoza, Julia Pasquale, Charlotte Leroy, Kristien Roelens, Griet Vandenberghe, M. Christian Urlyss Agossou, Sourou Goufodji Keke, Christiane Tshabu Aguemon, Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Rosalinda Hernández Muñoz, José Guilherme Cecatti, Carolina Ribeiro do Valle, Vincent Batiene, Kadari Cisse, Henri Gautier Ouedraogo, Kannitha Cheang, Phirun Lam, Tung Rathavy, Elie Simo, Pierre-Marie Tebeu, Emah Irene Yakana, Javier Carvajal, María Fernanda Escobar, Paula Fernández, Lotte Berdiin Colmorn, Jens Langhoff-Roos, Wilson Mereci, Paola Vélez, Yasser Salah Eldin, Alaa Sultan, Alula M. Teklu, Dawit Worku, Richard Adanu, Philip Govule, Charles Noora Lwanga, William Enrique Arriaga Romero, María Guadalupe Flores Aceituno, Carolina Bustillo, Bredy Lara, Vijay Kumar, Vanita Suri, Sonia Trikha, Irene Cetin, Serena Donati, Carlo Personeni, Guldana Baimussanova, Saule Kabylova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Zahida Qureshi, Raisa Asylbasheva, Aigul Boobekova, Damira Seksenbaeva, Saad Eddine Itani, Meilė Minkauskienė, Diana Ramašauskaitė, Owen Chikhwaza, Luis Gadama, Eddie Malunga, Haoua Dembele, Hamadoun Sangho, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Nazarea Herrera Maldonado, Juan I. Islas Castañeda, Tatiana Cauaus, Ala Curteanu, Victor Petrov, Yadamsuren Buyanjargal, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Zara Jaze, Arlete Mariano, Nafissa Bique Osman, Hla Mya Thway Einda, Thae Maung Maung, Khaing Nwe Tin, Tara Gurung, Amir Babu Shrestha, Sangeeta Shrestha, Kitty Bloemenkamp, Marcus J. Rijken, Thomas Van Den Akker, María Esther Estrada, Néstor J. Pavón Gómez, Olubukola Adesina, Chris Aimakhu, Bukola Fawole, Rizwana Chaudhri, Saima Hamid, M. Adnan Khan, María del Pilar Huatuco Hernández, Nelly M. Zavaleta Pimentel, Maria Lu Andal, Zenaida Dy Recidoro, Carolina Paula Martin, Mihaela Budianu, Lucian Puşcaşiu, Léopold Diouf, Dembo Guirassy, Philippe Marc Moreira, Miroslav Borovsky, Ladislav Kovac, Alexandra Kristufkova, Sylvia Cebekhulu, Laura Cornelissen, Priya Soma-Pillay, Vicenç Cararach, Marta López, María José Vidal Benedé, Hemali Jayakody, Kapila Jayaratne, Dhammica Rowel, Wisal Nabag, Sara Omer, Victoria Tsoy, Urunbish Uzakova, Dilrabo Yunusova, Thitiporn Siriwachirachai, Thumwadee Tangsiriwatthana, Catherine Dunlop, Marian Knight, David Lissauer, Jhon Roman, Gerardo Vitureira, Dinh Anh Tuan, Luong Ngoc Truong, Nghiem Thi Xuan Hanh, Mugove Madziyire, Thulani Magwali, Stephen Munjanja, Adama Baguiya, Mónica Chamillard, Seni Kouanda, Pisake Lumbiganon, Ashraf Nabhan, Ruta Nadisauskiene, Linda Bartlett, Fernando Bellissimo-Rodrigues, Shevin T. Jacob, Sadia Shakoor, Khalid Yunis, Liana Campodónico, Hugo Gamerro, Daniel Giordano, Fernando Althabe, A. Metin Gülmezoglu, and Obstetrics and Gynaecology

Subjects
medicine.medical_specialty, Cross-sectional study, Psychological intervention, Global Health, World Health Organization, Odds, Pregnancy, medicine, Medicine and Health Sciences, Infection control, Childbirth, Humans, Prospective Studies, Pregnancy Complications, Infectious, Poverty, business.industry, Medical record, MORTALITY, General Medicine, Odds ratio, Articles, medicine.disease, Cross-Sectional Studies, Treatment Outcome, Family medicine, Health Resources, Female, Health Facilities, business
Abstract

Background Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. Methods GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. Findings We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1middot84 [95% CI 1middot05-3middot22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2middot44 [1middot02-5middot85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). Interpretation While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development. Copyright (c) 2021 World Health Organization; licensee Elsevier. This is an Open Access article under the CC BY 3.0 IGO license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products, or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Published
2021

4. Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia

Author

Mattias Rööst, Víctor Conde Altamirano, Birgitta Essén, and Jerker Liljestrand

Subjects
Adult, Bolivia, Pediatrics, medicine.medical_specialty, Multivariate analysis, Population, Psychological intervention, Statistics, Nonparametric, Pregnancy, Risk Factors, medicine, Humans, Childbirth, Maternal Health Services, Prospective Studies, education, Emergency Treatment, Socioeconomic status, education.field_of_study, business.industry, Pregnancy Outcome, Obstetrics and Gynecology, Prenatal Care, General Medicine, Odds ratio, medicine.disease, Pregnancy Complications, Logistic Models, Socioeconomic Factors, Case-Control Studies, Emergency medicine, Female, Rural area, business
Abstract

Objective. To determine whether lack of routine antenatal care (ANC) is associated with near-miss morbidity upon arrival at hospital. Design. Case-referent study. Setting. Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government subsidized program. Sample. Women with severe maternal morbidity upon arrival at hospital (n = 297). Facility-matched referents with an uncomplicated childbirth at hospital (n = 297). Methods. Prospective inclusion of participants over a period of six months, using clinical and management-based criteria for near-miss. Multivariate logistic regression. Main outcome measures. Odds ratios (ORs) with 95% confidence intervals (CIs). Individual and joint effects of interacting variables. Results. Lack of ANC, lower education levels, and rural residence were interactively associated with near-miss upon arrival. Lack of ANC among women with limited education resulted in a four-fold greater risk for this condition. Such risk was considerably increased for women who lived in rural areas (OR 12.6; 95% CI 2.8-56.6). In addition, high maternal age and first time pregnancy were associated with near-miss upon arrival. Conclusions. This study identified subpopulations most likely to benefit from interventions designed to enable timely care-seeking for obstetric complications. ANC appears to facilitate utilization of emergency obstetric care, especially for women with socio-demographic disadvantages. Targeted initiatives to increase routine ANC may reduce severe maternal morbidity and mortality, both in urban and rural areas.

Published
2010

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