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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan

TitleThe development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan
Publication TypeJournal Article
Year of Publication2016
AuthorsBartlett, LA, LeFevre, AE, Mir, F, Soofi, S, Arif, S, Mitra, DK, Quaiyum, MA, Shakoor, S, Islam, MS, Connor, NE, Winch, PJ, Reller, ME, Shah, R, El Arifeen, S, Baqui, AH, Bhutta, ZA, Zaidi, A, Saha, S, Ahmed, SA
JournalReproductive Health
Volume13
Type of ArticleArticle
ISBN Number17424755 (ISSN)
KeywordsAdolescent, Adult, Algorithm, Anti-Bacterial Agents, antiinfective agent, Asymptomatic Infections, bacteremia, Bangladesh, clinical trial, cohort analysis, Cohort Studies, Community Health Workers, Culturally Competent Care, Developing Countries, developing country, drug effects, Endometritis, ethnology, Female, Gram negative bacterium, Gram positive bacterium, Gram-Negative Bacteria, Gram-positive bacteria, growth, development and aging, health auxiliary, home visit, House Calls, human, Humans, Incidence, infection, isolation and purification, Low-resource countries, maternal, Methods, microbiology, molecular typing, multicenter study, Pakistan, perinatal, postpartum, Postpartum Period, puerperal infection, Puerperal sepsis, puerperium, risk factor, Risk Factors, sepsis, South Asia, transcultural care, validation study, Young Adult
Abstract

Background: Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk. Methods/Design: The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics. Discussion: This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections. © 2016 Bartlett et al.