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.

ObjectivesKangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.DesignThis study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.Participants3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.Main outcome measuresThe primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.ResultsKey barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).ConclusionsThis study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.Trial registration numbersISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.

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...

Aim To learn how to achieve high‐quality, effective coverage of Kangaroo Mother Care (KMC), defined as 8 hours or more of skin‐to‐skin contact per day and exclusive breastfeeding in district Sonipat in North India, and to develop and evaluate an implementation model. Methods We conducted implementation research using a mixed‐methods approach, including formative research, followed by repeated, rapid cycles of implementation, evaluation and refinement until a model with the potential for high and effective coverage was reached. Evaluation of this model was conducted over a 12‐month period. Results Formative research findings informed the final implementation model. Programme learning was critical to achieve high coverage. The model included improving the identification of small babies, creating KMC wards, modification in hospitalisation criteria, private sector engagement and in‐built programme learning to refine implementation progress. KMC was initiated in 87% of eligible babies. At discharge, 85% received skin‐to‐skin contact care, 60% effective KMC and 80% were exclusively breastfed. At home, 7‐day post discharge, 81% received skin‐to‐skin care and 79% were exclusively breastfed in the previous 24 hours. Conclusion Achieving high KMC coverage is feasible in the study setting using a model responsive to the local context and led by the Government.

Objectives: The aim of the study is to understand antibiotic prescribing patterns and to understand knowledge of antibiotic resistance amongst the doctors working at public health facilities of a northern Indian state. Methodology: A cross-sectional study among doctors of the civil hospitals of Haryana state of India was conducted 2019. Data were collected by self-administered questionnaire from a total of 215 doctors posted at the 22 district hospitals. Results: The response rate was 98%. Doctors (66%) perceived antibiotic resistance as a very important global problem, a very important problem in India (68%) and as an important problem in their hospital (31%). Experience in years was significantly associated with considering hand hygiene (OR, 5.78; 95% CI, 1.6420.3; P = 0.005) and treatment of bacteria as per susceptibility report of the organism (OR, 0.54; 95% CI, 0.310.93; P = 0.03). Surgeons reported piperacillin-tazobactam (17%), cloxacillin (17%), and cephazolin (12.05%) and others (54.2%) as the first choice of antibiotics for infection after surgery. Doctors (52.3%) reported that they started antibiotics 12 hours before surgery; 15 (17%) prescribed antibiotics 6 hours before surgery; and 23 (27%) 1 day before the surgery. Time for stopping antibiotics after surgery, as reported by participants, was 1 day (15%), 23 days (35%), 57 days (44%), respectively. A total of 71 (83%) doctors thought that surgical incision could lead to post-surgical site infection. Conclusion: Findings of study can be utilized to enhance education on antimicrobial prescribing, antimicrobial surveillance, and prescribing patterns among doctors in our settings.