Birmingham experts join drive to address global burden of maternal sepsis

Photograph of a woman with a child.
Our work aims to reduce the number of mothers dying from maternal sepsis.

University of Birmingham health experts are working in a research partnership in East Africa that aims to reduce the number of mothers dying from maternal sepsis.

Every four minutes, a mother dies from a sepsis-related cause somewhere in the world, with the greatest burden borne by women in low and middle income countries.

The APT-Sepsis partnership aims to address this issue in Malawi and Uganda through an integrated programme with three interventional domains.

A complex intervention, researchers have developed the £3 million programme to target care provider behaviours across the care continuum, culminating in adherence to best practice in prevention and management of maternal sepsis.

Professor Arri Coomarasamy from the University of Birmingham said: “An apparently innocent infection can quickly turn into the catastrophe of sepsis, which is associated with multiple organ failure which is often the prelude to a mother’s death. The right patient, receiving the right treatment at the right time can make the difference between life and death.

“The APT-Sepsis intervention is designed to make it easy to do the right thing quickly and consistently – evaluating whether the intervention is effective, and giving policy-makers and healthcare practitioners the confidence to implement and scale-up the intervention.”

Researchers at the University of Birmingham have worked with colleagues at the University of Liverpool, which is leading the project.

Programme lead Professor David Lissauer, formerly of the University of Birmingham, said: “The recent WHO GLOSS (Global Sepsis) study suggested maternal sepsis may contribute to over half of all maternal deaths. Despite this, there has been little international focus on the issue. Reducing maternal mortality to reach the Sustainable Development Goal (SDG) target of less than 70 deaths per 100,000 births will require a comprehensive response.

“Although maternal death due to sepsis is the final devastating event, the origins of the problem often lie in multiple areas of poor quality of care including inconsistent infection prevention, poor infection treatment, delayed diagnosis of sepsis, and inadequate sepsis management. The APT-Sepsis intervention brings together evidence-based practice to address these issues via a integrated, scalable and sustainable approach.”

The three interventional domains are:

  • ‘Hand hygiene’: ensuring compliance with the WHO 5 moments of hand hygiene.
  • Infection prevention and management: ensuring adoption of evidence based practices for infection prevention in maternity, including appropriate antibiotic prophylaxis for high-risk women and improved surgical practices.
  • Better sepsis management: ensuring consistent measurement of patient vital signs and when there is suspected sepsis the triggering of the FAST-M maternal sepsis bundle (which includes fluids, antibiotics, source control, transfer and monitoring).

Senior Research Nurse Laura Munthali said: “Having worked in one of the busiest maternity units in Malawi, it is quite evident we have high numbers of maternal sepsis cases, but lacking a standardised approach to prevention, early identification, treatment and management results mostly to death. It is interesting to have the APT study for this cause, and for the benefit of our mothers not just in Malawi, but all low and middle-income countries.”

The project is funded by the MRC, NIHR, Wellcome and UK Aid Direct, and managed by the MRC.

Professor David Lissauer is also leading a related programme, LACTATE, which will show the accuracy of blood lactate in the diagnosis of maternal. This will be tested in pregnant mothers and those who have recently had their babies and suffer with infections, in Malawi, Uganda and Pakistan.

Measurement of blood lactate forms a key part of sepsis management and risk stratification in current international guidelines from both NICE and the Surviving Sepsis Campaign, however these guidelines were developed for non-pregnancy populations in high income countries.

The trial will investigate if lactate measurement, available as a point-of-care test, has incremental benefit over conventional maternal vital sign assessment in the diagnosis of sepsis and identification of women at risk of severe morbidity and mortality in Malawi, Pakistan and Uganda. The study will also investigate how this testing can be incorporated in current clinical practice.

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