About APT-Sepsis
What Is Maternal Sepsis?
The World Health Organization (WHO) define maternal sepsis as “A life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs during pregnancy, childbirth, post-abortion or the postpartum period.”
Why Is Maternal Sepsis Important?
It is estimated that maternal sepsis will claim the lives of 17,000 women every year, with about 12 million more affected, mainly in low- and middle-income countries.
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Many women will suffer devasting consequences of maternal infections and sepsis, including infertility (about 113,000 cases every year) and adverse perinatal outcomes.
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Reducing maternal and newborn deaths from infection is a priority, the WHO are leading efforts worldwide.
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A wide group of global partners working together developed the APT-Sepsis program to support hospitals in low resource settings to solve this problem and improve outcomes for mothers and their families.
What Is APT-Sepsis?
The Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) Intervention is a multi-component intervention that enables healthcare workers to meet 3 goals. The APT-Sepsis trial was a very large cluster randomized trial, conducted across 59 secondary level health facilities, across Uganda and Malawi.
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In this trial entire health facilities (clusters) were allocated to implement APT-Sepsis or carry on usual care, to see if APT-Sepsis could reduce maternal death or severe morbidity as the result of infection.
What Are The APT-Sepsis Goals?
Goal 1
Hand Hygiene At Every Moment
Hand hygiene is the cornerstone of infection prevention. Ensuring proper handwashing or hand-rub technique at every critical moment reduces the risk of infection spreading, protecting both mothers and newborns and preventing sepsis from developing across maternity wards and delivery settings.
Goal 2
Prevent And Treat Infection Using Best Practice
In addition to hand hygiene, best practice infection prevention includes appropriate antibiotic prophylaxis and safe, specialised care during procedures such as caesarean section. Applying these evidence-based measures helps reduce infections, prevent complications, and minimise the risk of maternal sepsis.
Goal 3
Suspect Sepsis, Start FAST–M
The final goal is to recognise sepsis early and act fast. Regular monitoring of maternal vital signs and awareness of red-flag symptoms enables timely diagnosis and treatment. Using the FAST–M bundle supports quick, coordinated responses that save lives and prevent long-term harm.
How is APT-Sepsis Implemented?
The APT-Sepsis program supports healthcare providers to achieve the 3 goals. To achieve this the healthcare providers must change their practices. We used the COM-B model to design the program to help providers change their behaviours.
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Hospital Leadership Engagement
Facility meeting were held and onboarding with leadership engagement.
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Champions
Identification and selection of Champions from existing staff roles such as clinical, management, pharmacy working in maternity locations. Champions were trained to co-deliver APT-Sepsis Programme to the facilities and provide ongoing staff mentorship.
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Multi-Professional Training And Mentorship
Training and mentorship supported by a range of resources.
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Implementation Tools
FAST-M Bundle consisting of MEOWS Chart, FAST-M decision and treatment checklist tools. Provision of ward based memory aids with posters, pocket reference and antibiotic guidelines gestation wheel. Soap and alcohol based handrub provided if required.
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Dashboards And Feedback Visits
Dashboard Malawi and Uganda demonstrating site performance and outcomes, quarterly site visits by hub team for supportive review.
What Is The COM-B Model
COM-B stands for Capability, Opportunity, Motivation, and Behaviour and provides a comprehensive framework for understanding why people behave as they do and how to facilitate meaningful behaviour change.
APT Sepsis Model
To achieve its central goals, the APT–Sepsis Programme required healthcare providers to improve their clinical practice.
This is complex process and required changes to be made in the way that people carry out their roles, as well as the way teams work together. These changes in clinical practice are known as ‘behaviour changes’.
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​When introducing a behaviour change, it is common to use a model to help make the change. The model used by the APT–Sepsis Programme to achieve its three core goals is the COM-B system.
The COM-B system of behaviour change draws on the concept that there must be the Capability, the ability needed for behaviour to happen an Opportunity, the time and circumstances needed for the behaviour to happen and a Motivation the reason for the Behaviour to happen improving patient care in the maternity setting.
The APT-Sepsis Trial
More information including the study Protocol, Participating facilities, Statistical analysis plan can be found on the Trial Registration: ISRCTN42347014. The study was also supported by the WHO and the Global Maternal and Neonatal Health initiative.
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Funding
This project was supported by the Joint Global Health Scheme with funding from the UK Foreign, Commonwealth and Development Office, the UK Medical Research Council (MRC), The UK Department of Health and Social Care through the National Institute of Health Research (NIHR) and Wellcome (Grant ref: MRV005782/1).
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HRP (UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction) and the NIHR programme Research Professorship (Grant Ref: NIHR300808) Global Health Professorship, Stopping mothers dying of Sepsis in Africa. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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The FAST-M bundle was developed with support from MSD, through MSD for Mothers, an initiative of Merck & Co., Inc., Rahway, NJ, U.S.A.
