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Original research
Early evaluation of the ‘STOP SEPSIS!’ WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries
  1. Vanessa Brizuela1,
  2. Mercedes Bonet1,
  3. Carla Lionela Trigo Romero2,
  4. Edgardo Abalos3,
  5. Adama Baguiya4,
  6. Bukola Fawole5,
  7. Marian Knight6,
  8. Pisake Lumbiganon7,
  9. Meilė Minkauskienė8,
  10. Ashraf Nabhan9,
  11. Nafissa Bique Osman10,
  12. Zahida P Qureshi11,
  13. João Paulo Souza2
  14. On behalf of the World Health Organization Global Maternal Sepsis Study Research Group
    1. 1UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
    2. 2Department of Social Medicine, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
    3. 3Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
    4. 4Research Institute of Health Sciences, Ouagadougou, Burkina Faso
    5. 5Department of Obstetrics and Gynaecology, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
    6. 6National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
    7. 7Obstetrics and Gynecology Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
    8. 8Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
    9. 9Department of Obstetrics and Gynaecology, Ain Shams University, Cairo, Egypt
    10. 10Department of Obstetrics/Gynaecology, Eduardo Mondlane University, Maputo, Mozambique
    11. 11Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
    1. Correspondence to Dr Vanessa Brizuela; brizuelav{at}


    Objective To evaluate changes in awareness of maternal sepsis among healthcare providers resulting from the WHO Global Maternal Sepsis Study (GLOSS) awareness campaign.

    Design Independent sample precampaign/postcampaign through online and paper-based surveys available for over 30 days before campaign roll-out (pre) and after study data collection (post). Descriptive statistics were used for campaign recognition and exposure, and odds ratio (OR) and percentage change were calculated for differences in awareness, adjusting for confounders using multivariate logistic regression.

    Setting and participants Healthcare providers from 398 participating facilities in 46 low, middle and high-income countries.

    Intervention An awareness campaign to accompany GLOSS launched 3 weeks prior to data collection and lasting the entire study period (28 November 2017 to 15 January 2018) and beyond.

    Main outcome measures Campaign recognition and exposure, and changes in awareness.

    Results A total of 2188 surveys were analysed: 1155 at baseline and 1033 at postcampaign. Most survey respondents found the campaign materials helpful (94%), that they helped increase awareness (90%) and that they helped motivate to act differently (88%). There were significant changes with regard to: not having heard of maternal sepsis (−63.4% change, pre-OR/post-OR 0.35, 95% CI 0.18 to 0.68) and perception of confidence in making the right decisions with regard to maternal sepsis identification and management (7.3% change, pre-OR/post-OR 1.44, 95% CI 1.01 to 2.06).

    Conclusions Awareness raising campaigns can contribute to an increase in having heard of maternal sepsis and an increase in provider perception of confidence in making correct decisions. Offering the information to make accurate and timely decisions while promoting environments that enable self-confidence and support could improve maternal sepsis identification and management.

    • maternal medicine
    • perinatology
    • public health

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    • Deceased Dr Bukola Fawole was deceased in January 2019

    • Collaborators WHO Global Maternal Sepsis Study Research Group (in alphabetical order): Afghanistan: Mohammad Iqbal Aman, Bashir Noormal. Argentina: Virginia Díaz, Marisa Espinoza, Julia Pasquale. Belgium: Charlotte Leroy, Kristien Roelens, Griet Vandenberghe. Benin: M Christian Urlyss Agossou, Sourou Goufodji Keke, Christiane Tshabu Aguemon. Bolivia: Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Rosalinda Hernández Muñoz. Brazil: José Guilherme Cecatti, Carolina Ribeiro do Valle. Burkina Faso: Vincent Batiene, Kadari Cisse, Henri Gautier Ouedraogo. Cambodia: Cheang Kannitha, Lam Phirun, Tung Rathavy. Cameroon: Elie Simo, Pierre-Marie Tebeu, Emah Irene Yakana. Colombia: Javier Carvajal, María Fernanda Escobar, Paula Fernández. Denmark: Lotte Berdiin Colmorn, Jens Langhoff-Roos. Ecuador: Wilson Mereci, Paola Vélez. Egypt: Yasser Salah Eldin, Alaa Sultan. Ethiopia: Abdulfetah Abdulkadir Abdosh, Alula M Teklu, Dawit Worku. Ghana: Richard Adanu, Philip Govule, Charles Noora Lwanga. Guatemala: William Enrique Arriaga Romero, María Guadalupe Flores Aceituno. Honduras: Carolina Bustillo, Rigoberto Castro, Bredy Lara. India: Vijay Kumar, Vanita Suri, Sonia Trikha. Italy: Irene Cetin, Serena Donati, Carlo Personeni. Kazakhstan: Guldana Baimussanova, Saule Kabylova, Balgyn Sagyndykova. Kenya: George Gwako, Alfred Osoti, Zahida Qureshi. Kyrgyzstan: Raisa Asylbasheva, Aigul Boobekova, Damira Seksenbaeva. Lebanon: Faysal El Kak, Saad Eddine Itani, Sabina Abou Malham. Lithuania: Meilė Minkauskienė, Diana Ramašauskaitė. Malawi: Owen Chikhwaza, Luis Gadama, Eddie Malunga. Mali: Haoua Dembele, Hamadoun Sangho, Fanta Eliane Zerbo. Mexico: Filiberto Dávila Serapio, Nazarea Herrera Maldonado, Juan I Islas Castañeda. Republic of Moldova: Tatiana Cauaus, Ala Curteanu, Victor Petrov. Mongolia: Yadamsuren Buyanjargal, Seded Khishgee, Bat-Erdene Lkhagvasuren. Morocco: Bouchra Assarag, Amina Essolbi, Rachid Moulki. Mozambique: Zara Jaze, Arlete Mariano, Nafissa Bique Osman. Myanmar: Hla Mya Thway Einda, Thae Maung Maung, Khaing Nwe Tin. Nepal: Tara Gurung, Amir Babu Shrestha, Sangeeta Shrestha. Netherlands: Kitty Bloemenkamp, Marcus J Rijken, Thomas Van Den Akker. Nicaragua: María Esther Estrada, Néstor J Pavón Gómez. Nigeria: Olubukola Adesina, Chris Aimakhu, Bukola Fawole. Pakistan: Rizwana Chaudhri, Saima Hamid, M Adnan Khan. Peru: María del Pilar Huatuco Hernández, Nelly M Zavaleta Pimentel. Philippines: Maria Lu Andal, Zenaida Dy Recidoro, Carolina Paula Martin. Romania: Mihaela Budianu, Lucian Pușcașiu. Senegal: Léopold Diouf, Dembo Guirassy, Philippe Marc Moreira. Slovakia: Miroslav Borovsky, Ladislav Kovac, Alexandra Kristufkova. South Africa: Sylvia Cebekhulu, Laura Cornelissen, Priya Soma-Pillay. Spain: Vicenç Cararach, Marta López, María José Vidal Benedé. Sri Lanka: Hemali Jayakody, Kapila Jayaratne, Dhammica Rowel. Sudan: Mohamed Elsheikh, Wisal Nabag, Sara Omer. Tajikistan: Victoria Tsoy, Urunbish Uzakova, Dilrabo Yunusova. Thailand: Thitiporn Siriwachirachai, Thumwadee Tangsiriwatthana. United Kingdom: Catherine Dunlop, Marian Knight, David Lissauer. Uruguay: Aquilino M Pérez, Jhon Roman, Gerardo Vitureira. Vietnam: Dinh Anh Tuan, Luong Ngoc Truong, Nghiem Thi Xuan Hanh. Zimbabwe: Mugove Madziyire, Thulani Magwali, Stephen Munjanja.

      Regional coordinators: Edgardo Abalos, Adama Baguiya, Mónica Chamillard, Bukola Fawole, Marian Knight, Seni Kouanda, Pisake Lumbiganon, Ashraf Nabhan, Ruta Nadisauskiene. Technical Advisory Group: Linda Bartlett, Fernando Bellissimo-Rodrigues, Shevin T Jacob, Sadia Shakoor, Khalid Yunis. Data management and analysis: Liana Campodónico, Cristina Cuesta, Hugo Gamerro, Daniel Giordano. WHO coordinating unit: Fernando Althabe, Mercedes Bonet, Vanessa Brizuela, A Metin Gülmezoglu, João Paulo Souza.

    • Contributors The evaluation plan and first draft of this original article was conceived by VB. MB provided substantial contributions to the data planning and analysis and first versions of this manuscript. The idea for the inclusion of an awareness campaign was first conceived by JPS. CLTR, JPS and EA provided additional feedback on first draft and data analysis. VB, MB, JPS, EA, AB, BF, MK, PL, MM, AN, NBO and ZPQ were instrumental to campaign design and implementation in their regions/countries and provided input to data collection tools used for this evaluation. All authors read and approved the final version. The WHO GLOSS Research Group contributed to different aspects of the study, from protocol development to acquisition of data and coordination of study in their countries. VB, MB and CLTR had full access to all the data and VB has final responsibility for the decision to submit for publication.

    • Funding This work was supported by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland (project A65787), Merck Sharp & Dohme, a wholly owned subsidiary of Merck and Co (Kenilworth, NJ, USA), through its Merck for Mothers programme, and the US Agency for International Development (USAID; grant number GHA-G-00-09-00003).

    • Disclaimer The views of the funding bodies have not influenced the content of this manuscript. This article represents the views of the named authors only and does not represent the views of the WHO.

    • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests All authors declare support from WHO/SHR, Merck for Mothers and USAID for the submitted work. VB, MB and JPS were employed by WHO at the time of the study. No other relationships or activities could appear to have influenced the submitted work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the entire study (GLOSS), including the awareness campaign, was obtained from WHO’s Ethics Review Committee in Geneva, Switzerland (protocol ID A65787) for a multisite, multicountry project, and from local and facility ethics committees as necessary. A legend was included in the survey stating that response to the survey implied consent to participate; respondents could recuse themselves at any point during the survey, including skipping and not answering certain questions.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All enquiries regarding the data and analyses can be made to the corresponding author.