Evaluation of the feasibility of the FAST-M maternal sepsis intervention in Pakistan: a protocol

Abstract

Background Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called “FAST-M” for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan. Methods The proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at the Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase (formative assessment), we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion. Qualitative data will be analyzed considering a framework method approach using NVivo version 10 (QSR International, Pty Ltd.) software. The qualitative results will guide the adaptation of FAST-M intervention in local context. In the second phase, we will evaluate the feasibility of the FAST-M intervention. Quantitative analyses will be done to assess numerous outcomes: process, organizational, clinical, structural, and adverse events with quantitative comparisons made before and after implementation of the bundle. Qualitative analysis will be done to evaluate the outcomes of intervention by conducting FGDs with HCPs involved during the implementation process. This will provide an understanding and validation of quantitative findings. Discussion The utilization of care bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate, and optimize a bundled care approach in low-resource settings in Pakistan to minimize the burden of maternal morbidities and mortalities due to sepsis.

Evaluation of the FAST-M maternal sepsis intervention in Pakistan: A qualitative exploratory study

“…Therefore, the importance of initial patient assessment and the significance of all the parameters to recognize early warning signs were stressed in training workshops. The HCPs were also provided hands-on training on monitoring early warning signs during FAST-M training workshops using different patient scenarios [ 16 ]. This effort improved patient monitoring during the intervention phase, as stated:…”

“…Hence a feasibility study was conducted to assess whether it is feasible to implement the FAST-M intervention for maternal sepsis care in Pakistan [ 16 ]. This paper presents the qualitative part of the FAST-M evaluation in Pakistan.…”

Early recognition and management of maternal sepsis in Pakistan: a feasibility study of the implementation of FAST-M intervention

“…The study protocol and procedures have been described in detail and published elsewhere. 23 To optimise the use of the FAST-M intervention in Pakistan, a qualitative study was conducted to understand the existing sepsis management practices/behaviours, and to identify potential gaps and resource availability in the local setting. 24 Based on the qualitative findings described in a separate paper and availability of resources in the facility, the FAST-M bundle care tools which were used in Malawi 21 were modified to plan a practical approach for the implementation of the intervention in our local context.…”

Maternal sepsis and factors associated with poor maternal outcomes in a tertiary hospital in Tigray, Ethiopia: a retrospective chart review

“…Maternal sepsis continues to cause significant mortality and morbidity worldwide. According to the WHO report, maternal sepsis is responsible for 10.7% of global maternal deaths annually [ 2 ]. Women in resource-limited countries shoulder most of the burdens related to sepsis.…”