Background

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.

Methods

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.

Findings

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).

Interpretation

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.

Funding

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.

中文翻译：

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世卫组织全球孕产妇败血症研究中设施资源和服务的可用性以及与感染相关的孕产妇结局：一项横断面研究

背景

感染是孕产妇死亡和发病的主要原因之一。世卫组织和合作伙伴于 2016 年发起的全球孕产妇败血症和新生儿倡议旨在减轻孕产妇感染和败血症的负担，是 2017 年实施全球孕产妇败血症研究 (GLOSS) 的基础。在本文中，我们旨在描述设施资源和服务的可用性，并分析它们与孕产妇结局的关系。

方法

GLOSS 是一项在 52 个国家/地区的 713 个医疗机构中实施的基于机构的、前瞻性的、为期 1 周的队列研究，包括 2850 名疑似或确诊感染的住院孕妇或新近孕妇。所有在 11 月 28 日至 12 月 4 日期间在任何参与机构在怀孕、分娩、产后或流产后因疑似或确诊感染而入院或住院的妇女都有资格入选。在这项研究中，我们包括了所有收集设施级数据的 GLOSS 参与设施（713 个设施中的 446 个）。我们使用了从接受过检查医疗记录的受过训练的研究人员为每位登记的妇女及其新生儿填写的个人表格中获得的数据，以及从医院管理人员为每个参与机构填写的机构表格中获得的数据。我们根据国家收入水平、根据妇女的需求和报告的可用性提供核心临床干预措施和服务的合规性以及与感染相关的孕产妇结局的严重程度来描述设施。我们使用逻辑多层次混合模型来评估设施特征与感染相关孕产妇结局之间的关联。

发现

我们纳入了来自 46 个国家的 446 家机构，共招募了 2560 名女性。我们发现产科护理和感染预防所需的大多数服务和资源的可用性很高。我们发现，在产后或流产后来自低收入国家机构的女性中，发生严重孕产妇结局的几率增加（调整后的几率 1·84 [95% CI 1·05–3·22]）和在怀孕或分娩期间从非城市设施登记的妇女中（调整后的优势比 2·44 [1·02–5·85]）。尽管总体依从性很高，但在测量呼吸频率（355 家设施中的 85 [24%]）和脉搏血氧饱和度测定（325 家设施中的 184 [57%]）方面的依从性较低。

解释

虽然照顾疑似或确诊感染的孕妇和最近怀孕的妇女的卫生保健设施可以获得广泛的资源和干预措施，但与高收入国家相比，低收入国家的新孕妇的孕产妇结局更差。国家；孕妇也有类似的趋势。遵守具有成本效益的临床实践和及时护理具有特定个体特征的女性可能会改善与感染相关的产妇结局。

资金

UNDP/UNFPA/UNICEF/WHO/世界银行人类生殖研究、发展和研究培训特别规划、WHO、默克母亲和美国国际开发署。