Maternal sepsis: Africa gets a grip on preventable postpartum infection

Eleven out of every 1,000 new mothers globally contract postpartum infections that could potentially lead to organ dysfunction or even death.

The more shocking aspect of the data, cited in the 2020 Global Maternal Sepsis Study (GLOSS) by the World Health Organisation (WHO), is that these deaths are all preventable.

Days after she gave birth to her son in a Ugandan hospital, Grace Nalwoga almost fell victim to the vicious cycle of postpartum infection.

What started as a normal recovery from childbirth quickly became a crisis as Grace came down with a fever so strong that she felt life ebb out of her.

"The heat and pain inside me were overwhelming," Grace tells TRT Afrika. "I grew weaker by the hour. I remember looking at my newborn and fearing I wouldn't live to see him grow."

Grace had developed a severe maternal infection that progressed to sepsis, a life-threatening condition where the body's response to infection damages tissues and organs.

She is one of countless women for whom the joy of childbirth is overshadowed by the spectre of sepsis-linked maternal deaths in Africa and many other parts of the world.

Many of these new mothers die because hospitals don't consistently follow basic hygiene and treatment protocols.

WHO identifies rigorous hand hygiene, early detection and timely treatment as the three key determinants of preventing maternal sepsis.

Life-saving protocols

In Malawi, Alice Kambalame's battle with a post-surgical infection unfolded after a prolonged labour that culminated in her giving birth by caesarean section.

"After the surgery, I knew something was wrong," Alice tells TRT Afrika. "The wound was red and painful, and I felt dizzy and confused. The doctors and nurses acted very quickly. They told me I had an infection and started treatment immediately. I believe their speed saved my life."

The difference between Grace's narrow escape and Alice's rapid treatment is what a new study has now institutionalised.

Research published in the New England Journal of Medicine by WHO, the UN's Special Programme in Human Reproduction (HRP) and the University of Liverpool shows that a structured approach to infection prevention and control can reduce severe maternal infections and deaths by over 30%.

The trial, conducted across 59 hospitals in Malawi and Uganda and involving over 431,000 women, led to the implementation of the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) programme.

The initiative supports healthcare workers in bridging gaps in care by reinforcing WHO's "five moments for hand hygiene", applying proven guidance on infection prevention, and using the "FAST-M treatment bundle" – fluids, antibiotics, source control, transfer if required, and monitoring.

Impactful intervention

Hospitals using the APT-Sepsis protocol saw a 32% reduction in infection-related maternal mortality and severe morbidity.

They also reported significant improvements in hand-hygiene compliance, the use of antibiotic prophylaxis during C-sections, and routine monitoring of vital signs to catch infections early.

"The APT-Sepsis programme is proof of what can be achieved when science, policy and frontline care come together," says Dr Jeremy Farrar, assistant director-general at WHO.

"Reducing maternal infections and deaths by over 30% is not just a clinical success; it's a call to action for global healthcare systems to prioritise infection prevention in maternal care. We must ensure these life-saving practices are scaled and sustained across all settings."

Small victories

For mothers like Alice, there is finally a system in place to prevent postpartum infections and ensure timely and effective care if sepsis happens to strike.

The model's success in Malawi and Uganda has prompted WHO and its partners to scale this approach within national healthcare systems worldwide.

As Grace watches her son play, she feels grateful to be able to share what she went through so that others don't.

 "Thank God, I survived to tell my story," Grace tells TRT Afrika. "When I see my son happy and playful, I think of all the other mothers who will get to see their children grow because of this new care protocol. That is a beautiful victory."