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.

Abstractobjective In Morocco, medical care for women with severe obstetric complications (near-miss cases) ends at discharge from the hospital. Little information exists regarding what happens after returning home. The aim of the study was to assess the physical and mental health consequences of near-miss events on Moroccan women 8 months after childbirth.methods A prospective cohort study of 76 near-miss women was conducted in three hospitals. For every case, we recruited at least two women from the same hospital who had uncomplicated deliveries (n = 169). We used a mixed-methods approach. For the quantitative part, we analysed sociodemographic characteristics collected via a questionnaire and medical complications extracted from the medical records during a medical consultation at 8 months post-partum. Forty in-depth interviews were also conducted with 20 near-miss cases and 20 women with uncomplicated deliveries.results The near-miss women were poorer and less educated than those who had uncomplicated deliveries. The proportion of physical consequences (serious illness) was higher among near-miss cases (22%) than uncomplicated deliveries (6%, P = 0.001). The risk of depression was significantly higher among near-miss cases with perinatal death (OR = 7.16; [95% CI: 2.85-17.98]) than among those who had an uncomplicated delivery. Interviews revealed that the economic burden of near-miss care contributed to social problems among the women and their households.conclusion A near-miss event has consequences that go beyond the first days after delivery. Developing new mechanisms for maternal and newborn health follow-up is essential and should address the mother's physical and mental health problems and involve husbands and family members.

BackgroundGestational Diabetes Mellitus (GDM) testing and management in Morocco is associated with delays resulting in late commencement of treatment. To reduce delays and to increase access of women to GDM care, a country-adapted intervention targeting primary health care providers was designed to test the hypothesis that detection and initial management of GDM at the primary level of care improves newborn outcomes in terms of lower birthweights and less cases of macrosomia and impacts on maternal weight gain, glucose balance and pregnancy outcomes.Materials and methodsWe conducted a cluster randomized controlled trial in two districts of Morocco. In each district, 10 health centers were randomly selected to serve either as intervention or control sites. Pregnant women attending antenatal care in the study facilities were eligible to participate. At the intervention sites, women were offered GDM screening by capillary glucose testing following International Association of Diabetes in Pregnancy Study Groups/WHO criteria. Women diagnosed with GDM received counselling on nutrition and exercise and were followed up through their health center whereas at control facilities routine practice was applied. Primary outcome was birthweight and secondary outcomes maternal weight gain, glucose control and pregnancy complications. We further assessed GDM prevalence in the intervention arm. Statistical analysis was performed on 210 recruited women. Continuous variables were reported using means while categorical variables using frequencies with tests of independence applying chi-squared tests. Differences of outcome variables between the two groups were estimated by mixed-effects regression models and effect sizes adjusted for confounders. The trial is registered under NCT02979756 at ClinicalTrials.gov.ResultsGDM prevalence reached 23.7% in Marrakech. Birthweight in the intervention group was 147grams lower than in the control group (p = 0.08) as was the proportion of macrosomes (3.5% versus 18.4%; p< 0.001). In the intervention arm, women did two times more follow-ups than at control sites (p = 0.001) and mean follow-up intervals were shorter (11.3 days versus 18.7 days; p < 0.001). Overall, 30% more fasting blood sugar values were balanced (p = 0.005) and mean weekly maternal weight gain 49 grams lower (p = 0.032) in the intervention group. More women from control facilities had a delivery complication whereas more newborn complications were observed in women from intervention facilities. No difference between the two groups existed regarding mode of delivery and mean gestational age at delivery. One of the main limitations of the study was the Hawthorn-effect at control sites that might have led to an underestimation of the effect size.ConclusionA high GDM prevalence in Morocco calls for a context-adapted screening and management approach to enable early interventions. GDM detection and care through antenatal care at primary health facilities may have positively impacted on newborn birthweight but findings are inconclusive. ...

Updating knowledge and skills of providers through both pre- and in-service-training needs to be supported by uniform national standards enabling first line health care workers to manage women with GDM and thus increase access and provide a continuity in care. Findings of this study will be used to pilot a model of GDM screening and initial management through the primary level of care.

BackgroundIn Morocco, gestational diabetes affects 1 in 10 pregnant women, but knowledge about screening and management practices outside university settings is limited.ObjectiveTo provide a comprehensive picture about the current situation of screening and management of gestational diabetes at different levels of care and to highlight existing challenges.DesignWe conducted a descriptive mixed methods study in the districts of Al Haouz and Marrakech by using both quantitative and qualitative methods, including document reviews of 369 antenatal cards and 299 hospital files, health facility inventories related to resource availability, 20 key informant interviews as well as focus group discussions with 32 pregnant women and exit interviews with 122 antenatal care (ANC) clients. Quantitative data were descriptively analyzed using STATA Version 13, whereas qualitative data were thematically analyzed using NVIVO Version 10.ResultsThe findings revealed that sensitization of women about gestational diabetes is low, and only 34.4% have ever heard about it before attending ANC. Fasting blood sugar is used for screening, and women are sent to external laboratories for testing. A fasting blood sugar of 0.92 g/l and above was documented in 12.3% of all antenatal cards examined. Women diagnosed with gestational diabetes are usually referred to a specialist despite general practitioners at health center level being responsible for the management of non-pregnant diabetic patients.ConclusionsDecentralization of screening for gestational diabetes and initial management of uncomplicated cases at the primary level of care could ease access to care and reduce the number of mothers who are diagnosed after a complication occurred.