Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study: a cross-sectional study
Authors: Vanessa Brizuela, Cristina Cuesta, Gino Bartolelli, Abdulfetah Abdulkadir Abdosh, Sabina Abou Malham, Bouchra Assarag, Rigoberto Castro Banegas, Virginia Díaz, Faysal El-Kak, Mohamed El Sheikh, Aquilino M Pérez, João Paulo Souza, Mercedes Bonet, Edgardo Abalos, Vanessa Brizuela, Cristina Cuesta, Gino Bartolelli, Abdulfetah Abdulkadir Abdosh, Sabina Abou Malham, Bouchra Assarag, Rigoberto Castro, Virginia Díaz, Faysal El Kak, Mohamed Elsheikh, Aquilino M. Pérez, João Paulo Souza, Mercedes Bonet, Edgardo Abalos, Mohammad Iqbal Aman, Bashir Noormal, Marisa Espinoza, Julia Pasquale, Charlotte Leroy, Kristien Roelens, Griet Vandenberghe, M. Christian Urlyss Agossou, Sourou Goufodji Keke, Christiane Tshabu Aguemon, Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Rosalinda Hernández Muñoz, José Guilherme Cecatti, Carolina Ribeiro do Valle, Vincent Batiene, Kadari Cisse, Henri Gautier Ouedraogo, Kannitha Cheang, Phirun Lam, Tung Rathavy, Elie Simo, Pierre-Marie Tebeu, Emah Irene Yakana, Javier Carvajal, María Fernanda Escobar, Paula Fernández, Lotte Berdiin Colmorn, Jens Langhoff-Roos, Wilson Mereci, Paola Vélez, Yasser Salah Eldin, Alaa Sultan, Alula M. Teklu, Dawit Worku, Richard Adanu, Philip Govule, Charles Noora Lwanga, William Enrique Arriaga Romero, María Guadalupe Flores Aceituno, Carolina Bustillo, Bredy Lara, Vijay Kumar, Vanita Suri, Sonia Trikha, Irene Cetin, Serena Donati, Carlo Personeni, Guldana Baimussanova, Saule Kabylova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Zahida Qureshi, Raisa Asylbasheva, Aigul Boobekova, Damira Seksenbaeva, Saad Eddine Itani, Meilė Minkauskienė, Diana Ramašauskaitė, Owen Chikhwaza, Luis Gadama, Eddie Malunga, Haoua Dembele, Hamadoun Sangho, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Nazarea Herrera Maldonado, Juan I. Islas Castañeda, Tatiana Cauaus, Ala Curteanu, Victor Petrov, Yadamsuren Buyanjargal, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Zara Jaze, Arlete Mariano, Nafissa Bique Osman, Hla Mya Thway Einda, Thae Maung Maung, Khaing Nwe Tin, Tara Gurung, Amir Babu Shrestha, Sangeeta Shrestha, Kitty Bloemenkamp, Marcus J. Rijken, Thomas Van Den Akker, María Esther Estrada, Néstor J. Pavón Gómez, Olubukola Adesina, Chris Aimakhu, Bukola Fawole, Rizwana Chaudhri, Saima Hamid, M. Adnan Khan, María del Pilar Huatuco Hernández, Nelly M. Zavaleta Pimentel, Maria Lu Andal, Zenaida Dy Recidoro, Carolina Paula Martin, Mihaela Budianu, Lucian Puşcaşiu, Léopold Diouf, Dembo Guirassy, Philippe Marc Moreira, Miroslav Borovsky, Ladislav Kovac, Alexandra Kristufkova, Sylvia Cebekhulu, Laura Cornelissen, Priya Soma-Pillay, Vicenç Cararach, Marta López, María José Vidal Benedé, Hemali Jayakody, Kapila Jayaratne, Dhammica Rowel, Wisal Nabag, Sara Omer, Victoria Tsoy, Urunbish Uzakova, Dilrabo Yunusova, Thitiporn Siriwachirachai, Thumwadee Tangsiriwatthana, Catherine Dunlop, Marian Knight, David Lissauer, Jhon Roman, Gerardo Vitureira, Dinh Anh Tuan, Luong Ngoc Truong, Nghiem Thi Xuan Hanh, Mugove Madziyire, Thulani Magwali, Stephen Munjanja, Adama Baguiya, Mónica Chamillard, Bukola Fawole, Marian Knight, Seni Kouanda, Pisake Lumbiganon, Ashraf Nabhan, Ruta Nadisauskiene, Linda Bartlett, Fernando Bellissimo-Rodrigues, Shevin T. Jacob, Sadia Shakoor, Khalid Yunis, Liana Campodónico, Hugo Gamerro, Daniel Giordano, Fernando Althabe, A. Metin Gülmezoglu
Journal: The Lancet Global Health (2021)

Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes.GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes.We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05-3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02-5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities).While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes.UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development.