ObjectiveA maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called ‘FAST-M’ consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation.SettingThe study was conducted at the Liaquat University of Medical and Health Sciences, which is a tertiary referral public sector hospital in Hyderabad.Design and participantsA qualitative exploratory study comprising key informant interviews and a focus group discussion was conducted with healthcare providers (HCPs) working in the study setting between November 2020 and January 2021, to ascertain the potential facilitators and barriers to the implementation of the FAST-M intervention. Interview guides were developed using the five domains of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting, characteristics of the individuals and process of implementation.ResultsFour overarching themes were identified, the hindering factors for implementation of the FAST-M intervention were: (1) Challenges in existing system such as a shortage of resources and lack of quality assurance; and (2) Clinical practice variation that includes lack of sepsis guidelines and documentation; the facilitating factors identified were: (3) HCPs’ perceptions about the FAST-M intervention and their positive views about its execution and (4) Development of HCPs readiness for FAST-M implementation that aided in identifying solutions to potential hindering factors at their clinical setting.ConclusionThe study has identified potential gaps and probable solutions to the implementation of the FAST-M intervention, with modifications for adaptation in the local contextTrial registration numberISRCTN17105658.

Background: Oral health inequalities are becoming a major threat to public health, and they excessively burden disadvantaged communities, especially within low and middle-income countries. This study explored the socioeconomic inequalities in self-perceived oral health behaviors among college-going students in Karachi, Pakistan. Methods: A cross-sectional study was conducted among 328 college-going students using a convenient sampling technique from three different socioeconomic groups including urban slums, middle, and rich class neighborhoods. Oral health was assessed using three measures: daily tooth brushing, weekly sweet consumption, and substance abuse. Socio-economic inequalities were measured using binary logistic regression (odds ratios), relative index of inequality, and slope index of inequality. Results: Out of 328 participants, 56.4% perceived their oral health as fair, 24.1% good, 14.9% poor, while only 4.6% had an excellent perception of oral health. Significant inequalities were found regarding oral health behaviours with fraternal income, occupation, and education level. Education-related absolute inequalities among college-going students were1.28(95% CI -2.19, -0.36 p-value<0.01), -1.34(95% CI -2.16, -0.52, p-value<0.01), -1.43(95% CI -2.70, -0.15, p-value<0.01) with tooth brushing, high sweet consumption, and substance abuse respectively. Similarly, income and occupation-related absolute inequalities were also existent. Conclusions: In Pakistan, data among college-going students regarding oral healthcare is scarce. Significant inequalities were found in oral health behaviours among college-going students. Thus, there is a need to design equity-based health system provisions specifically to address the needs of poor segments of society.

ObjectiveMaternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (Fluids,Antibiotics,Source identification and treatment,Transfer andMonitoring) for early identification and management of maternal sepsis in low-resource settings. This study aimed to determine feasibility of FAST-M intervention in a low-resource setting in Pakistan. The FAST-M intervention consists of maternal sepsis screening tools, treatment bundle and implementation programme.Design and settingA feasibility study with before and after design was conducted in women with suspected maternal sepsis admitted at the Liaquat University of Medical and Health Sciences hospital Hyderabad. The study outcomes were compared between baseline and intervention phases. In the baseline phase (2 months), the existing sepsis care practices were recorded, followed by a training programme for healthcare providers on the application of FAST-M tools. These tools were implemented in the intervention phase (4 months) to assess any change in clinical practices compared with the baseline phase.ResultsDuring the FAST-M implementation, 439 women were included in the study. 242/439 were suspected maternal infection cases, and 138/242 were women with suspected maternal sepsis. The FAST-M bundle was implemented in women with suspected maternal sepsis. Following the FAST-M intervention, significant changes were observed. Improvements were seen in the monitoring of oxygen saturation measurements (25.5% vs 100%; difference: 74%; 95% CI: 68.4% to 80.5%; p<0.01), fetal heart rate assessment (58% vs 100%; difference: 42.0%; 95% CI: 33.7% to 50.3%; p≤0.01) and measurement of urine output (76.5% vs 100%; difference: 23.5%; 95% CI: 17.6% to 29.4%; p<0.01). Women with suspected maternal sepsis received all components of the treatment bundle within 1 hour of sepsis recognition (0% vs 70.5%; difference: 70.5%; 95% CI: 60.4% to 80.6%; p<0.01).ConclusionImplementation of the FAST-M intervention was considered feasible and enhanced early identification and management of maternal sepsis at the study site.Trial registration numberISRCTN17105658.

Introduction The World Health Organization and partners developed and evaluated a maternity-specific sepsis care bundle called ‘FAST-M’ for low-resource settings. However, this bundle has not yet been studied in Asia. Our study sought to evaluate the perceptions of healthcare providers about the implementation of the FAST-M intervention in Pakistan. Materials and methods The study was conducted at a public sector hospital in Hyderabad. We conducted three focus group discussions with healthcare providers including doctors, nurses, and healthcare administrators (n = 22) who implemented the FAST-M intervention. The Consolidated Framework for Implementation Research was used as a guiding framework for data collection and analysis. The data were analyzed using a thematic analysis approach and deductive methods. Results Five overarching themes emerged: (I) FAST-M intervention and its significance including HCPs believing in the advantages of using the intervention to improve clinical practices; (II) Influence of outer and inner settings including non-availability of resources in the facility for sepsis care; (III) HCPs perceptions about sustainability, which were positive (IV) Integration into the clinical setting including HCPs views on the existing gaps, for example, shortage of HCPs and communication gaps, and their recommendations to improve these; and (V) Outcomes of the intervention including improved clinical processes and outcomes using the FAST-M intervention. Significant improvement in patient monitoring and FAST-M bundle completion within an hour of diagnosis of sepsis was reported by the HCPs. Conclusions The healthcare providers’ views were positive about the intervention, its outcomes, and long-term sustainability. The qualitative data provided findings on the acceptability of the overall implementation processes to support subsequent scaling up of the intervention.