Title
Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
Date Issued
01 May 2020
Access level
open access
Resource Type
journal article
Author(s)
Bonet M.
Brizuela V.
Abalos E.
Cuesta C.
Baguiya A.
Chamillard M.
Fawole B.
Knight M.
Kouanda S.
Lumbiganon P.
Nabhan A.
Nadisauskiene R.J.
Abdulkadir A.
Adanu R.M.
Aman M.I.
Arriaga Romero W.E.
Assarag B.
Bloemenkamp K.W.M.
Boobekova A.
Budianu M.A.
Cararach V.
Castro R.
Cebekhulu S.
Cecatti J.G.
Colmorn L.B.
Curteanu A.
Donati S.
Einda H.M.T.
El Deen Y.S.
El Kak F.
Elsheikh M.
Escobar-Vidarte M.F.
Espinoza M.M.
Estrada M.E.
Gadama L.A.
Goufodji S.B.
Hamid S.
Hernandez Munoz R.
Herrera Maldonado N.
Jayaratne K.
Kabylova S.
Kristufkova A.
Kumar V.
Lissauer D.
Mereci W.
Minkauskiene M.
Moreira P.
Munjanja S.
Osman N.B.
Ouedraogo H.G.
Perez A.M.
Pasquale J.
Puscasiu L.
Qureshi Z.
Recidoro Z.
Ribeiro-do-Valle C.C.
Rowel D.
Sangho H.
Shrestha A.B.
Siriwachirachai T.
Tebeu P.M.
Tin K.N.
Tuan D.A.
Tung R.
Vandenberghe G.
Yadamsuren B.
Yunusova D.
Noormal B.
Díaz V.
Leroy C.
Roelens K.
Agossou M.C.U.
Tshabu Aguemon C.
Apaza Peralta P.S.
Conde Altamirano V.
Batiene V.
Cisse K.
Cheang K.
Lam P.
Simo E.
Yakana E.I.
Carvajal J.
Fernández P.
Langhoff-Roos J.
Vélez P.
Sultan A.
Teklu A.M.
Worku D.
Govule P.
Noora Lwanga C.
Flores Aceituno M.G.
Bustillo C.
Lara B.
Suri V.
Trikha S.
Cetin I.
Personeni C.
Baimussanova G.
Sagyndykova B.
Publisher(s)
Elsevier Ltd
Abstract
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.
Start page
e661
End page
e671
Volume
8
Issue
5
Language
English
OCDE Knowledge area
Obstetricia, Ginecología
Scopus EID
2-s2.0-85083674405
PubMed ID
Source
The Lancet Global Health
ISSN of the container
2214109X
Sponsor(s)
We sincerely thank the women who participated in this study. WHO is grateful to the extensive network of institutions and individuals who contributed to the project design and implementation, including researchers, study coordinators, data collectors, data clerks, and other partners including the staff from the Ministries of Health and WHO offices. We would like to acknowledge the contribution and lifelong achievements of our co-author Bukola Fawole, who passed away before the publication of this Article. This study is financially supported by the UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland (project A65787), Merck Sharp & Dohme, a wholly owned subsidiary of Merck (Kenilworth, NJ, USA), through its Merck for Mothers programme, and the United States Agency for International Development (grant GHA-G-00-09-00003). The views of the funding bodies have not influenced the content of this manuscript.
Sources of information:
Directorio de Producción Científica
Scopus