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

Bonet, Mercedes, Brizuela, Vanessa, Abalos, Edgardo, Cuesta, Cristina, Baguiya, Adama, Chamillard, Mónica, Fawole, Bukola, Knight, Marian, Kouanda, Seni, Lumbiganon, Pisake, Nabhan, Ashraf, Nadisauskiene, Ruta J, Abdulkadir, Abdulfetah, Adanu, Richard MK, Aman, Mohammad Iqbal, Arriaga Romero, William E., Assarag, Bouchra, Bloemenkamp, Kitty W.M., Boobekova, Aigul, Budianu, Mihaela A., Cararach, Vicenç, Castro, Rigoberto, Cebekhulu, Sylvia, Cecatti, José Guilherme, Colmorn, Lotte Berdiin, Curteanu, Ala, Donati, Serena, Einda, Hla Mya Thway, El Deen, Yasser Salah, El Kak, Faysal, Elsheikh, Mohamed, Escobar-Vidarte, Maria F, Espinoza, Marisa Mabel, Estrada, María Ester, Gadama, Luis Aaron, Goufodji, Sourou B, Hamid, Saima, Hernandez Munoz, Rosalinda, Herrera Maldonado, Nazarea, Jayaratne, Kapila, Kabylova, Saule, Kristufkova, Alexandra, Kumar, Vijay, Lissauer, David, Mereci, Wilson, Minkauskiene, Meile, Moreira, Philippe, Munjanja, Stephen, B. Osman, Nafissa, Ouedraogo, Henri Gautier, Perez, Aquilino M., Pasquale, Julia, Puscasiu, Lucian, Qureshi, Zahida, Recidoro, Zenaida, C. Ribeiro-do-Valle, Carolina, Rowel, Dhammica, Sangho, Hamadoun, Shrestha, Amir Babu, Siriwachirachai, Thitiporn, Tebeu, Pierre Marie, Tin, Khaing Nwe, Tuan, Dinh Anh, Tung, Rathavy, Vandenberghe, Griet, Yadamsuren, Buyanjargal, Yunusova, Dilrabo, Zavaleta Pimentel, Nelly, Noormal, Bashir, Díaz, Virginia, Leroy, Charlotte, Roelens, Kristien, Agossou, M. Christian Urlyss, Tshabu Aguemon, Christiane, Apaza Peralta, Patricia Soledad, Conde Altamirano, Víctor, Batiene, Vincent, Cisse, Kadari, Cheang, Kannitha, Lam, Phirun, Simo, Elie, Yakana, Emah Irene, Carvajal, Javier, Fernández, Paula, Langhoff-Roos, Jens, Vélez, Paola, Sultan, Alaa, Teklu, Alula M., Worku, Dawit, Govule, Philip, Noora Lwanga, Charles, Flores Aceituno, María Guadalupe, Bustillo, Carolina, Lara, Bredy, Suri, Vanita, Trikha, Sonia, Cetin, Irene, Personeni, Carlo, Baimussanova, Guldana, Sagyndykova, Balgyn, Gwako, George, Osoti, Alfred, Asylbasheva, Raisa, Seksenbaeva, Damira, Itani, Saad Eddine, Abou Malham, Sabina, Ramašauskaitė, Diana, Chikhwaza, Owen, Malunga, Eddie, Dembele, Haoua, Sangho, Hamadoun, Zerbo, Fanta Eliane, Dávila Serapio, Filiberto, Islas Castañeda, Juan I., Cauaus, Tatiana, Petrov, Victor, Khishgee, Seded, Lkhagvasuren, Bat-Erdene, Essolbi, Amina, Moulki, Rachid, Jaze, Zara, Mariano, Arlete, Maung, Thae Maung, Gurung, Tara, Shrestha, Sangeeta, Rijken, Marcus J., Van Den Akker, Thomas, Estrada, María Esther, Pavón Gómez, Néstor J., Adesina, Olubukola, Aimakhu, Chris, Chaudhri, Rizwana, Khan, M. Adnan, Huatuco Hernández, María del Pilar, Andal, Maria Lu, Martin, Carolina Paula, Diouf, Léopold, Guirassy, Dembo, Borovsky, Miroslav, Kovac, Ladislav, Cornelissen, Laura, Soma-Pillay, Priya, López, Marta, Vidal Benedé, María José, Jayakody, Hemali, Elsheikh, Mohamed, Nabag, Wisal, Omer, Sara, Tsoy, Victoria, Uzakova, Urunbish, Tangsiriwatthana, Thumwadee, Dunlop, Catherine, Roman, Jhon, Vitureira, Gerardo, Truong, Luong Ngoc, Hanh, Nghiem Thi Xuan, Madziyire, Mugove, Magwali, Thulani, Bartlett, Linda, Bellissimo-Rodrigues, Fernando, Jacob, Shevin ORCID: https://orcid.org/0000-0003-2425-9394, Shakoor, Sadia, Yunis, Khalid, Campodónico, Liana, Gamerro, Hugo, Giordano, Daniel, Althabe, Fernando, Gülmezoglu, A. Metin and Souza, João Paulo (2020) 'Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study'. Lancet Global Health, Vol 8, Issue 5, e661-e671.

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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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 240 Bacteremia. Sepsis. Toxemias WQ Obstetrics > WQ 100 General works WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/S2214-109X(20)30109-1
Depositing User:	Stacy Murtagh
Date Deposited:	21 May 2020 14:11
Last Modified:	21 May 2020 14:11
URI:	https://archive.lstmed.ac.uk/id/eprint/14499

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