Maternal infection and sepsis are among the leading causes of maternal death and severe illness worldwide, particularly in low- and middle-income countries. Inconsistent infection prevention practices, delayed recognition of sepsis, and inadequate treatment contribute to thousands of preventable maternal deaths each year. Infections during and after pregnancy are also linked to long-term complications for women and adverse outcomes for babies, including stillbirth and neonatal death.
APT-Sepsis Programme Strengthens Infection Prevention and Control
A new cluster-randomised trial conducted across 59 health facilities in Malawi and Uganda evaluated the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) programme. This multicomponent intervention aimed to help healthcare providers adhere to World Health Organization hand-hygiene standards, adopt evidence-based maternal infection prevention practices, and implement the FAST-M sepsis treatment bundle, which includes fluids, antibiotics, source control, transfer if required, and monitoring.
Early Detection of Maternal Sepsis Improves Outcomes
The programme prioritises early recognition of maternal sepsis, enabling timely intervention to prevent progression to severe illness or death. Structured care bundles like FAST-M have previously improved outcomes for obstetric emergencies, and APT-Sepsis adapts these principles for infection prevention and treatment in low-resource settings.
Cluster-Randomised Trial Shows Reduced Maternal Deaths
The trial included over 431,000 births. Facilities implementing APT-Sepsis saw 1.4% of women experience severe infection-related outcomes, compared with 1.9% in usual-care facilities, representing a 32% relative reduction. The benefit was consistent across countries, facility sizes, and sustained over time, demonstrating the effectiveness of structured, multicomponent interventions in improving maternal outcomes.
Implications for Maternal Health in Low-Resource Settings
These results underscore the importance of system-level interventions to improve infection prevention, early sepsis detection, and timely treatment. Scaling up programmes like APT-Sepsis could save thousands of lives, reduce severe maternal illness, and help low- and middle-income countries achieve global maternal health targets.
Reference
Lissauer D et al. A multicomponent intervention to improve maternal infection outcomes. N Engl J Med. 2025; DOI:10.1056/NEJMoa2512698.
