Abstract
To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings.
Highlights
Maternal sepsis is a life-threatening condition defined as organ dysfunction that results from infection during pregnancy, delivery, or the postabortion or postpartum period.[1]
The present study is the first to evaluate the availability of recognized key resources for the management of maternal sepsis in Malawi and across other low-income and lower-middle- income countries
The findings show that low-income countries have severe limitations in the availability of resources for the management of maternal sepsis
Summary
Maternal sepsis is a life-threatening condition defined as organ dysfunction that results from infection during pregnancy, delivery, or the postabortion or postpartum period.[1]. Malawi was the focus of the current project; it is an example of a country with a high sepsis morbidity and mortality.[4,5] It has been selected as the location for a feasibility study examining the introduction of a maternal sepsis bundle designed for use in the maternity population in low-income countries. This will form part of a wider WHO maternal sepsis program.[11]. The present study aimed to investigate the perceived availability of key resources for maternal sepsis management and SSC guideline/ bundle implementation in health centers and hospitals in Malawi, and to compare resource availability across hospitals in Malawi, other low- income countries, and lower-middle-income countries
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