New Research from the WHO Global Maternal Sepsis Study (GLOSS) + Exclusive Interview with Study Lead Dr. Bonet
On Tuesday, April 28th, the newest research from the Global Maternal Sepsis Study was published in The Lancet. On this important occasion, we were able to speak to Dr. Mercedes Bonet, Study Lead at the World Health Organization (WHO), exclusively.
Marvin Zick: Please introduce the Global Maternal Sepsis Study (GLOSS).
Mercedes Bonet: The Global Maternal Sepsis Study (GLOSS) was a massive research effort led by the World Health Organization to better understand and stop maternal sepsis.
If we can understand why maternal sepsis is still a leading cause of death for women and newborns we will be better equipped to combat it. GLOSS is the first study to provide data on the frequency of maternal infections across the pregnancy and post-pregnancy period, in over 700 health facilities across 52 countries. The data collection was also accompanied by a campaign for healthcare providers, which increased their awareness and understanding of maternal sepsis identification and management.
MZ: Please introduce yourself.
MB: My name is Dr. Mercedes Bonet and I am a medical officer working at the WHO Department of Sexual and Reproductive Health which also hosts HRP, the main instrument within the United Nations system for research in human reproduction.
While I oversaw the study from WHO headquarters in Geneva, it was really a concerted global effort that engaged over 100 researchers across the 52 participating countries who supported the development of the study protocol, led the data collection, and the implementation of the awareness campaign.
MZ: Can you Please summarize the findings from the recent publication?
MB: The WHO GLOSS Research Group, which published results in The Lancet Global Health on April 28th, shows that infection has a much larger impact on global maternal mortality and morbidity than previously thought.
This is mainly due to two factors.
First, the underlying contribution of maternal infection to adverse maternal outcomes. Women may have died or developed severe morbidity from other complications, such as postpartum haemorrhage, but infection was present. Second, unlike previous estimates, GLOSS reports not only on direct (obstetric) infections, but also on infections after abortion and indirect (non-obstetric) infections, in keeping with the WHO maternal sepsis definition across the continuum of pregnancy, childbirth, and post-pregnancy periods.
The study also highlights important gaps regarding the early identification and management of maternal infections in health facilities. For example, a third of women did not have a complete set of vital signs reported on the day of suspicion or diagnosis of the infection.
Finally, we found that the most common infections are highly preventable with good quality care across the pregnancy and post-pregnancy continuum.
MZ: What surprised you most about the results of the study?
MB: The true burden of maternal sepsis has been unknown, owing to a lack of data, in particular for low- and middle-income countries. It was not a surprise, so much as an urgent step forward for GLOSS to address the absence of standardized data from those countries and to see more clearly what is actually happening around the world.
This is critical for prevention, early diagnosis, and prompt management of maternal and neonatal infection, which we know will save lives and directly contribute to the achievement of Sustainable Development Goal 3.
MZ: Can you explain the differences between low- and middle-income countries and high-income countries?
MB: Most maternal infections are preventable and treatable, but efforts to prevent, diagnose, and treat maternal infection are linked to broader health determinants and different country contexts.
Overcrowding, limited access to water and sanitation, substandard infection prevention and control measures, limited resources, including staff, supplies and equipment, and constraints to safe births by skilled birth attendants can reduce the ability of healthcare providers to manage the frequency and outcome of maternal infections. These factors may explain why the highest ratios of maternal infection and severe maternal outcomes were observed in low and middle-income countries.
MZ: What do you think is the reason for maternal sepsis not getting the attention it deserves globally?
MB: For a long time, the focus has been on addressing the two main maternal killers: post-partum haemorrhage and pregnancy-induced hypertension. Although we knew sepsis deaths due to obstetric infections were just next on the list, data on maternal infections were less frequent and often of limited quality.
Alongside our GLOSS results, there has been other important work on sepsis this year. Incidence estimates and an evidence synthesis on the incidence of peripartum infections, commissioned by WHO, confirmed that maternal infections are a real problem, and deserve more attention.
Prevention and management of maternal infections are complex challenges and require a comprehensive response. This must be at all levels, from addressing individual-level risk factors (such as anemia or obesity) to behavioral changes by staff to improve monitoring and use of preventive measures.
Finally, improvements in infrastructure and resources are key. Attention to maternal sepsis is growing, but health facilities need investment in clean water and sanitation, infection prevention and control measures, training, and equipment.
It is extremely encouraging that WHO will publish a global sepsis epidemiology report in May around the 73rd World Health Assembly (WHA). This is in response to the 2017 WHA Resolution on Improving the prevention, diagnosis, and clinical management of sepsis.
MZ: What are the next steps for GLOSS and the WHO? Did the study point out any opportunities or untapped potential?
GLOSS presents, for the first time, a more complete understanding of the frequency and impact of maternal infections in health facilities.
Our hope is that GLOSS has answered some important questions about the role of maternal infection and sepsis in global maternal mortality and morbidity. With these data, healthcare providers, policy-makers, and the public at large are better equipped to mobilize, improve evidence-based practice, and save lives.
WHO is committed to improving the prevention and management of maternal infections through its research and normative work. Under the umbrella of the Global Maternal and Newborn Sepsis Initiative we are working with healthcare workers, researchers, and policymakers so that together we can stop maternal sepsis.
The data collection was also accompanied by an awareness-raising campaign for healthcare providers, which could improve maternal sepsis identification and management.
MZ: Is there anything else our audience should take away from the Global Maternal Sepsis Study?
MB: Every pregnant or recently pregnant woman is at risk of an infection that could trigger sepsis, regardless of where she lives.
Significant efforts are needed to develop and implement comprehensive approaches for effective prevention, improved identification, monitoring, and management of maternal infections and sepsis in health facilities.
Please visit http://srhr.org/sepsis for more information and resources about GLOSS.
Press Release
Please download the GSA press release below or use the press release template to issue one on behalf of your organization.
The above interview was conducted by Marvin Zick via email on April 30th, 2020. A big thanks to Dr. Bonet and the WHO Communications Team for putting this together so quickly.