Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.

BackgroundHealth systems in many countries do not adequately address non-communicable diseases (NCDs) during pregnancy, especially in low- and middle-income countries. In Myanmar, most studies on NCDs have investigated risk factors and prevalence of NCDs in the general population. This study aimed to assess the level of knowledge of common NCDs and nutritional need during pregnancy and to identify the factors associated with such knowledge, in three townships of Ayeyarwaddy region in Myanmar.MethodsA cross-sectional study was conducted among pregnant women aged between 18 and 49 years. We interviewed 630 pregnant women by using a pretested structured questionnaire. Knowledge questionnaire had five categories: general knowledge in NCDs, hypertension, diabetes, anemia, and nutritional need during pregnancy. Knowledge scores ranged from 0 to 56. We used Bloom’s cut-off point to classify the knowledge into three levels: low level as 59% or below (0–33 scores), moderate level as 60–80% (34–49 scores), and high level as 80–100% (50–56 scores). We conducted multiple linear regression analyses to find the association between different exposure variables (behavioral risk factors, pre-existing NCDs in pregnant women, and family history of NCDs) and knowledge on common NCDs and nutritional need during pregnancy adjusted for socioeconomic factors.ResultsAmong pregnant women, 64.8% had moderate level of knowledge, 22.7% had low level, and only 12.5% had high level. The mean knowledge scores were 39.6 (standard deviation 10.2). Pregnant women with the following factors were more likely to have higher knowledge: their belonging to the second, middle, and fourth quintiles of wealth index and their family members’ status of having some kind of NCDs.ConclusionsMajority of pregnant women had low to moderate level of knowledge on common NCDs and nutritional need during pregnancy. Wealth and family history of NCDs were significantly associated with their knowledge. Prevention and promotion of NCDs should be integrated in maternal and child health programs and should emphasize for the pregnant women who are in the poorest or richest wealth quintiles and who do not have family history of NCDs.

Background Access to family planning contributes up to a 44% reduction in maternal deaths. Since the majority of unplanned pregnancies and abortions occur in women who were either not using contraception or not using it consistently, greater access to contraception and more consistent use of contraception are crucial in the reduction of unplanned pregnancies and abortions. This study aims to determine which types of contraceptives are most often discontinued, the reasons for discontinuation, and the factors that influence contraceptive discontinuation for women in Myanmar. Methods This study is a secondary data analysis of calendar data from the 2015–16 Myanmar Demographic Health Survey. The dependent variable is discontinuation of contraception within 12 months among episodes of contraceptive use in the 5 years before the survey among women age 15–49. Multivariable logistic regression was used to identify the predictors of contraceptive discontinuation. Results The 12-month discontinuation rate for all contraceptive methods was 39%. The discontinuation rates for short-term methods were remarkably high (43% for pills and 42% for injectables), while the rate for long-term methods was very low (7% for intrauterine devices and 0.2% for implants). Discontinuation while still in need of contraception was high (55%) although 28% of those women switched to other modern methods. Multivariable logistic regression showed the factors associated with contraceptive discontinuation were a woman’s age, location (state/region), wealth, and number of births within the past 5 years. Conclusions The high rate of discontinuation while in need is very alarming given goals to reduce the unmet need for family planning in Myanmar. Family planning programs must ensure timely, informed method-switching by women who discontinue contraception, especially among women for whom discontinuation is the highest (age 45–49, middle and richest wealth quintile, regions where high discontinuation and multiparity); increase the availability of long-term contraceptive methods, and improve counseling that ensures clients’ informed and voluntary choice of family planning services.

Summary 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...