The FAST-M complex intervention for the detection and management of maternal sepsis in low-resource settings: a multi-site evaluation

J Cheshire*, L Jones, L Munthali, C Kamphinga, H Liyaya, T Phiri, W Parry-Smith, C Dunlop, C Makwenda, A J Devall, A Tobias, B Nambiar, A Merriel, H M Williams, I Gallos, A Wilson, A Coomarasamy, D Lissauer

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Objective

To evaluate whether the implementation of the FAST‐M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low‐resource setting.

Design

A before‐and‐after design.

Setting

Fifteen government healthcare facilities in Malawi.

Population

Women suspected of having maternal sepsis.

Methods

The FAST‐M complex intervention consisted of the following components: the FAST‐M maternal sepsis treatment bundle and the FAST‐M implementation programme. Performance of selected process outcomes was compared between a 2‐month baseline phase and 6‐month intervention phase with compliance used as a proxy measure of feasibility.

Main outcome result

Compliance with vital sign recording and use of the FAST‐M maternal sepsis bundle.

Results

Following implementation of the FAST‐M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST‐M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis.

Conclusion

Implementation of the FAST‐M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low‐resource setting such as Malawi.

Tweetable Abstract

Implementation of a sepsis care bundle for low‐resources improved recognition & management of maternal sepsis.

Original languageEnglish
Pages (from-to)1324-1333
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume128
Issue number8
Early online date3 Mar 2021
DOIs
Publication statusPublished - Jul 2021

Bibliographical note

Funding Information:
Research funding was provided by MSD for Mothers, University of Birmingham and the charity Ammalife. Funds from MSD were provided through its MSD for Mothers programme. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, N J, USA. DL, AC, JC, AW and CD all work as volunteers with the charity Ammalife. Those engaged in the work were excluded from the funding decision made by Ammalife. None of the funders had input into the study design, data collection, data analysis, data interpretation or writing of the report.

Funding Information:
MSD for Mothers, University of Birmingham (RG_16-150) and Ammalife (1120236). The authors wish to thank all the staff at the healthcare facilities for all their hard work and willingness to engage in the FAST-M intervention, and to Parent and Child Health Initiative Trust (PACHI) for the day-to-day in-country management of the study.

Publisher Copyright:
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Keywords

  • care bundle
  • complex intervention
  • feasibility study
  • low-resource setting
  • maternal sepsis

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