Stopping mothers dying from sepsis in Africa

I am a scientist and maternal and fetal medicine specialist, recently appointed as Professor of Global Maternal and Fetal Health at the University of Liverpool. I am based full-time in Malawi. My programme of work aims to reduce mortality and morbidity from maternal sepsis in Africa.

Over the next 5-years I will undertake a broad programme of research, in 3 workstreams: Workstream 1: Understanding maternal infection in Malawi There is the urgent need for better information on maternal infections and morbidity outcomes in Malawi.

I will lead the development of a maternal infection and severe maternal outcome surveillance system, that will be piloted in Blantyre district, Malawi.

We will also co-design clinician and public facing dashboards, to enable the surveillance data to be used for quality improvement.

It is well recognised that care delays often contribute to adverse outcomes, and we will develop and pilot a novel geospatial location approach to explore these care delays and map infection and delay hotspots.

We will link surveillance data to laboratory data to understand the aetiology of these infections and the antimicrobial resistance profiles.

Workstream 2: Preventing infections; focussing on caesarean section and miscarriage surgery Infection is 20 times more likely after caesarean birth.

We will conduct a research priority setting exercise, following a modified James Lind Alliance approach, with a broad stakeholder group to prioritise 10 uncertainties in the prevention of infection after caesarean section. One of the priority topics will be selected for a pilot study in preparation for a full trial.

The WHO has highlighted evidence based recommendations to reduce infections after caesarean section yet surveys of practice show these are not performed reliably.

We will utilise a behavioural change perspective to co-design an intervention to improve compliance with these practices at caesarean section and miscarriage surgery.

Workstream 3: Improving the management of maternal sepsis We will investigate if lactate measurement, available as a point-of-care test, has incremental benefit over conventional maternal vital sign assessment in the diagnosis of sepsis and identification of women at risk of severe morbidity and mortality.

We will also aim to test at scale if a maternal sepsis bundle based approach (FAST-M) is clinically effective in reducing maternal infection related mortality and severe morbidity and if it is cost effective.

A robust mixed methods implementation evaluation will also be conducted to understand the way the intervention functions in practice.

These 3 workstreams will be accompanied by 2 cross cutting themes: Training and capacity building: We will support Malawian researchers and clinicians to develop their research careers and become the next generation of leading scientists.

Communication with the public, practitioners and policy makers: We will throughout be communicating about the research we are doing with the public to raise the profile of women's health issues and the importance of maternal infections and sepsis.