Acronym FAST-M = Fluids, Antibiotics, Source identification, Transport/transfer, Monitoring

Background: Maternal sepsis is “a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or the post-partum period”. In Malawi post-partum sepsis accounts for 9.9% of all maternal deaths. In Malawi, a report on the Confidential Enquiry into Maternal Deaths highlighted deficiencies in the prompt recognition and inadequate management of maternal sepsis, concluding that the use of early warning scores and a structured approach to patient monitoring, alongside an educational programme to improve the recognition and management of maternal sepsis would likely improve sepsis care. In high-income settings there is evidence that this approach can improve patient outcomes however none of these interventions are specific to the maternal population or designed to be feasible in resource-poor settings.

Objectives:

1. Optimise the content and delivery of the FAST-M decision and treatment tools and the on-site training programme.
2. Assess whether the use of the FAST-M bundle is feasible in the Malawian healthcare system and improves sepsis care.
3. Prepare the FAST-M intervention for a large-scale intervention trial.
4. Adapt WHO tools for hand hygiene and guidance on infection prevention and treatment in obstetrics, for use in the Malawian healthcare system, and audit adherence to this guidance.
5. Improve maternal sepsis recognition and management by enhancing the FAST-M maternal sepsis bundle with the addition of lactate testing and pulse oximetry (FAST-M+).