Abstract
BackgroundAn awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers’ knowledge, perception of enabling environments, and perception of severity of maternal sepsis.MethodsWe used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ2. Logistic regressions were performed to adjust for selected variables.ResultsAnalysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities.ConclusionsAwareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.
Highlights
An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017
Qualitative – semi-structured interviews We developed a guide for the interviews based on existing literature on maternal infections and sepsis, qualitative methodology, and our framework for conceptualising awareness to obtain information on barriers and facilitators, indicators and determinants, and perceptions of severity of maternal health conditions that might influence the identification and management of maternal sepsis [18, 20, 23, 24]. (See Additional file 1 for a copy of the interview guide.) We hypothesized that if interviewees did not see sepsis as a problem, their engagement with the study, and especially with the campaign, would be hindered
Following our definition of awareness, we present the most salient findings according to the three constructs that we included: knowledge on maternal sepsis, perception of enabling environments, and perception of severity of disease
Summary
An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. One of the first actions taken by this initiative was to obtain consensus on a new definition for maternal sepsis as “a lifethreatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or postpartum period” [2]. Within this context, the Global Maternal Sepsis Study (GLOSS) and the accompanying maternal sepsis awareness campaign implemented in 2017 in 53 low-, middle-, and highincome countries across the world, were devised by the World Health Organization (WHO) to both assess the burden and management of maternal sepsis at a global level and to raise awareness on maternal sepsis among healthcare providers [3]. Awareness has been described at times as a precursor to action, at others as having heard of a specific issue, and most often measured through discrete assessments of increased knowledge alone [10, 12,13,14]
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