Sepsis Programme Cuts Maternal Deaths and Severe Infections in Africa – European Medical Journal

Report on the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) Programme and its Contribution to Sustainable Development Goals

Introduction: Maternal Sepsis as a Barrier to Achieving SDG 3

Maternal infection and sepsis represent significant obstacles to the achievement of Sustainable Development Goal 3 (Good Health and Well-being), particularly Target 3.1, which aims to reduce the global maternal mortality ratio. These conditions are leading causes of preventable maternal death and severe morbidity, with a disproportionate impact on low- and middle-income countries. Furthermore, maternal infections are linked to adverse neonatal outcomes, including stillbirth and neonatal death, thereby impeding progress towards SDG Target 3.2, which seeks to end preventable deaths of newborns.

The APT-Sepsis Intervention: A Framework for Quality Healthcare and System Strengthening

The Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) programme is a multicomponent, system-level intervention designed to improve the quality of maternal healthcare, in alignment with SDG Target 3.8 (Achieve universal health coverage). The programme was evaluated in a cluster-randomised trial across 59 health facilities in Malawi and Uganda. Its primary objectives are to strengthen health system capacity (SDG Target 3.d) by promoting adherence to evidence-based standards.

• Enhanced adherence to World Health Organization hand-hygiene standards.
• Systematic adoption of evidence-based maternal infection prevention practices.
• Effective implementation of a structured sepsis treatment bundle.

A central component of the intervention is the FAST-M sepsis treatment bundle, which facilitates early recognition and timely management of maternal sepsis. The bundle consists of five critical actions:

1. Fluids
2. Antibiotics
3. Source Control
4. Transfer (if required)
5. Monitoring

Clinical Trial Findings: Measurable Progress Towards Maternal Health Targets

The trial, which included over 431,000 births, demonstrated the programme’s significant impact on maternal health outcomes. These results provide strong evidence for an effective strategy to accelerate progress on SDG 3.

• Facilities implementing the APT-Sepsis programme recorded a 32% relative reduction in severe infection-related maternal outcomes compared to facilities providing usual care.
• The incidence of severe outcomes decreased from 1.9% in the control group to 1.4% in the intervention group.
• The positive impact was consistent across both countries and various facility sizes, indicating the programme’s robustness and potential for scalability.

Conclusion: Scaling Up for Global Impact on Health and Gender Equality

The success of the APT-Sepsis programme underscores the critical importance of structured, system-level interventions to improve infection prevention, ensure early sepsis detection, and provide timely treatment. Scaling up such programmes is essential for low- and middle-income countries to achieve global maternal health targets outlined in SDG 3. By preventing thousands of maternal deaths and reducing severe illness, these interventions not only advance public health but also contribute to SDG 5 (Gender Equality) by safeguarding the lives and long-term well-being of women.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The primary Sustainable Development Goal (SDG) addressed in the article is:

• SDG 3: Good Health and Well-being

  The article directly focuses on improving maternal health outcomes, a central component of SDG 3. It discusses the problem of “maternal infection and sepsis” as a “leading cause of maternal death and severe illness worldwide.” The entire purpose of the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) programme is to prevent these deaths and illnesses, thereby promoting the well-being of mothers and their babies. The concluding sentence explicitly states that scaling up such programmes could help countries “achieve global maternal health targets,” directly linking the intervention to this goal.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the focus of the article, the following specific targets under SDG 3 can be identified:

1. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

   The article is centered on reducing maternal deaths caused by infection and sepsis. It highlights that these conditions “contribute to thousands of preventable maternal deaths each year.” The success of the APT-Sepsis programme in achieving a “32% relative reduction” in severe infection-related outcomes is a direct contribution to lowering maternal mortality and morbidity, aligning perfectly with this target.

2. Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age.

   The article establishes a clear link between maternal health and infant health by stating that infections during and after pregnancy are linked to “adverse outcomes for babies, including stillbirth and neonatal death.” By preventing and treating maternal infections, the programme indirectly works towards reducing preventable newborn deaths, which is the core objective of this target.

3. Target 3.8: Achieve universal health coverage, including access to quality essential health-care services.

   The APT-Sepsis programme is a “multicomponent intervention” designed to improve the quality of care in health facilities. It aims to help healthcare providers “adhere to World Health Organization hand-hygiene standards, adopt evidence-based maternal infection prevention practices, and implement the FAST-M sepsis treatment bundle.” These actions represent a tangible effort to improve the quality and reliability of essential healthcare services for pregnant women in low-resource settings, which is a key aspect of universal health coverage.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several indicators that can be used to measure progress:

• Indicator for Target 3.1 (Maternal Mortality): Percentage of women experiencing severe infection-related outcomes.

  The article provides specific data for this indicator. It states that in facilities implementing the APT-Sepsis programme, “1.4% of women experience severe infection-related outcomes, compared with 1.9% in usual-care facilities.” This quantifiable measure serves as a direct indicator of progress in reducing severe maternal morbidity, which is a precursor to mortality.

• Indicator for Target 3.2 (Neonatal Mortality): Rate of stillbirth and neonatal death.

  While the article does not provide specific numbers for this, it is an implied indicator. Since the text links maternal infections to “stillbirth and neonatal death,” measuring the rates of these outcomes in facilities with and without the intervention would be a logical way to assess the programme’s impact on achieving Target 3.2.

• Indicators for Target 3.8 (Quality of Care): Adherence to infection prevention and treatment protocols.

  The article implies several process indicators that measure the quality of healthcare services. Progress could be tracked by measuring:

  • The rate of adherence by healthcare providers to “World Health Organization hand-hygiene standards.”
  • The adoption rate of “evidence-based maternal infection prevention practices.”
  • The proportion of sepsis cases managed using the “FAST-M sepsis treatment bundle.”

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: emjreviews.com