The FAST‐M complex intervention for the detection and management of maternal sepsis in low‐resource settings: a multi‐site evaluation

Cheshire, J; Jones, L; Munthali, L; Kamphinga, C; Liyaya, H; Phiri, T; Parry‐Smith, W; Dunlop, C; Makwenda, C; Devall, AJ; Tobias, A; Nambiar, B; Merriel, A; Williams, HM; Gallos, I; Wilson, A; Coomarasamy, A; Lissauer, D

Abstract

Objective
To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting.

Design
A before-and-after design.

Setting
Fifteen government healthcare facilities in Malawi.

Population
Women suspected of having maternal sepsis.

Methods
The FAST-M complex intervention consisted of the following components: the FAST-M maternal sepsis treatment bundle and the FAST-M implementation programme. Performance of selected process outcomes was compared between a 2-month baseline phase and 6-month intervention phase with compliance used as a proxy measure of feasibility.

Main outcome result
Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle.

Results
Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis.

Conclusion
Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi.

Tweetable Abstract
Implementation of a sepsis care bundle for low-resources improved recognition & management of maternal sepsis.

Citation

Cheshire, J., Jones, L., Munthali, L., Kamphinga, C., Liyaya, H., Phiri, T., Parry‐Smith, W., Dunlop, C., Makwenda, C., Devall, A., Tobias, A., Nambiar, B., Merriel, A., Williams, H., Gallos, I., Wilson, A., Coomarasamy, A., & Lissauer, D. (2021). The FAST‐M complex intervention for the detection and management of maternal sepsis in low‐resource settings: a multi‐site evaluation. BJOG: An International Journal of Obstetrics and Gynaecology, 128(8), 1324–1333. https://doi.org/10.1111/1471-0528.16658

• Journal Article Type: Article
• Acceptance Date: Nov 2, 2020
• Online Publication Date: Feb 4, 2021
• Publication Date: 2021-07
• Deposit Date: Mar 28, 2024
• Journal: BJOG: An International Journal of Obstetrics & Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 128
• Issue: 8
• Pages: 1324–1333
• DOI: https://doi.org/10.1111/1471-0528.16658
• Keywords: care bundle, complex intervention, feasibility study, low-resource setting, maternal sepsis
• Public URL: https://keele-repository.worktribe.com/output/773474
• Publisher URL: http://dx.doi.org/10.1111/1471-0528.16658