The global maternal sepsis study and awareness campaign (GLOSS): study protocol

Ashraf Nabhan,Joao Paulo Souza,A Metin Gülmezoglu,Ruta Nadisauskiene,Seni Kouanda,Vanessa Brizuela,Bukola Fawole,Mercedes Bonet,Edgardo Abalos,Marian Knight,Pisake Lumbiganon

doi:10.1186/s12978-017-0437-8

Abstract

BackgroundMaternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis.MethodsThis is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days.DiscussionGLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action.

Highlights

A better understanding of clinical presentation and current management strategies of maternal and early neonatal sepsis will be the basis for the development of effective intervention methodologies to improve prevention and adoption of evidence-based practices
This will directly address the needs of women and neonates affected by infection and its complications, in settings where women, and in consequence fetuses and newborns, have limited access to health services given their social or cultural context
In particular given the increase in facility-based childbirths and rising caesarean section rates that may affect the burden of maternal and neonatal sepsis

Summary

Introduction

Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. Pregnancy-related infections are the third commonest direct cause of maternal deaths, representing about 11% of all maternal deaths [1]. Pregnancy-related infections contribute significantly to many deaths attributed to other conditions [2]. The burden of maternal deaths directly associated with infection is higher in low- and middle-income countries (LMIC) (10.7%), with the greatest burden in Southern Asia (13.7%) and SubSaharan Africa (10.3%), compared to high-income countries (HIC) (4.7%) [1]. Less frequent in HICs, maternal infections remain an important cause of maternal mortality in some of them [3, 4]. Infections are an important cause of indirect maternal deaths, including malaria, dengue, pyelonephritis, influenza-like illness and HIV/AIDS [5]. Some systemic infections are more frequent or serious during pregnancy (e.g. malaria, tuberculosis, influenza, herpes) [7]

Objectives

Methods

Findings

Conclusion