The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan

Abstract

BackgroundPostpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk.Methods/DesignThe objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics.DiscussionThis is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.

Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

“…The Initiative notes the importance of infection in maternal and newborn morbidity and mortality; the goals include research on the burden and causes, prevention, and management, and information/advocacy [ 55 ]. Community-based mother and newborn surveillance systems with identification, appropriate biosampling, and management, such as those implemented in South Asia, can shed further light on the microbiology, along with the epidemiology of maternal infection, including GBS [ 56 ].…”

Progress and inequities in maternal mortality in Afghanistan (RAMOS-II): a retrospective observational study

“…35 The challenging context merits innovation: promising interventions include walking blood banks and diagnostic and referral methods for community health workers to identify newborn and maternal sepsis. 36 As mobile phone technology has flourished, exploring mHealth applications to promote care-seeking and facilitate referrals is merited. 37 Addressing the snow-bound winters in Ragh merits exploration of simple transport methods used in other countries with severe winter conditions, for example, snowshoes and dog-sleds for transporting ill women.…”

Vaccines for maternal immunization against Group B Streptococcus disease: WHO perspectives on case ascertainment and case definitions

“…However, until standard clinical criteria are determined, a simple, sensitive and pragmatic approach is needed to guide case ascertainment for maternal GBS sepsis. We suggest that all pregnant, post-abortion and postpartum women up to 42 days after delivery with a temperature >38 °C should be investigated with blood sampling (for culture and culture-independent diagnostic tests (CIDTs)), or where sepsis is clinically suspected, or where there is a history of fever and clinical suspicion of endometritis (abdominal pain or foul smelling vaginal discharge) or chorioamnionitis [51]. This is suggested as a sensitive approach, to maximise case detection.…”