abstract: 'Background Maternal morbidity and mortality related to infection is an

  international public health concern, but detection and assessment is

  often difficult as part of routine maternity care in many low- and

  middle-income countries due to lack of easily accessible diagnostics.

  Front-line healthcare providers are key for the early identification and

  management of the unwell woman who may have infection. We sought to

  investigate the knowledge, attitudes, and perceptions of the use of

  screening tools to detect infectious maternal morbidity during and after

  pregnancy as part of routine antenatal and postnatal care. Enabling

  factors, barriers, and potential management options for the use of early

  warning scores were explored. Methods Key informant interviews (n = 10)

  and two focus group discussions (n = 14) were conducted with healthcare

  providers and managers (total = 24) working in one large tertiary public

  hospital in Blantyre, Malawi. Transcribed interviews were coded by topic

  and then grouped into categories. Thematic framework analysis was

  undertaken to identify emerging themes. Results Most healthcare

  providers are aware of the importance of the early detection of

  infection and would seek to better identify women with infection if

  resources were available to do so. In current practice, an early warning

  score was used in the high dependency unit only. Routine screening was

  not in place in the antenatal or postnatal departments. Barriers to

  implementing routine screening included lack of trained staff and time,

  lack of thermometers, and difficulties with the interpretation of the

  early warning scores. A locally adapted early warning screening tool was

  considered an enabler to implementing routine screening for infectious

  morbidity. Local ownership and clinical leadership were considered

  essential for successful and sustainable implementation for clinical

  change. Conclusions Although healthcare providers considered infection

  during and after pregnancy and childbirth a danger sign and significant

  morbidity, standardised screening for infectious maternal morbidity was

  not part of routine antenatal or postnatal care. The establishment of

  such a service requires the availability of free and easy to access

  rapid diagnostic testing, training in interpretation of results, as well

  as affordable targeted treatment. The implementation of early warning

  scores and processes developed in high-income countries need careful

  consideration and validation when applied to women accessing care in low

  resource settings.'
affiliation: 'McCauley, M (Corresponding Author), Liverpool Womens Hosp, Liverpool
  Womens NHS Fdn Trust, Crown St, Liverpool L8 7SS, Merseyside, England.

  Slezak, Emilia; Unger, Holger; McCauley, Mary, Univ Liverpool Liverpool Sch Trop
  Med, Ctr Maternal \& Newborn Hlth, Liverpool, Merseyside, England.

  Unger, Holger, Royal Darwin Hosp, Dept Obstet \& Gynaecol, Darwin, NT, Australia.

  Unger, Holger, Charles Darwin Univ, Menzies Sch Hlth Res, Darwin, NT, Australia.

  Gadama, Luis, Queen Elizabeth Hosp, Blantyre, Malawi.

  McCauley, Mary, Liverpool Womens Hosp, Liverpool Womens NHS Fdn Trust, Crown St,
  Liverpool L8 7SS, Merseyside, England.'
article-number: '362'
author: Slezak, Emilia and Unger, Holger and Gadama, Luis and McCauley, Mary
author-email: mary.mccauley1@lwh.nhs.uk
author_list:
- family: Slezak
  given: Emilia
- family: Unger
  given: Holger
- family: Gadama
  given: Luis
- family: McCauley
  given: Mary
da: '2023-09-28'
doi: 10.1186/s12884-022-04583-5
eissn: 1471-2393
files: []
journal: BMC PREGNANCY AND CHILDBIRTH
keywords: 'Maternal morbidity; Infections; Early warning scores; Healthcare

  providers; Antenatal care; Postnatal care; SARS-CoV-2'
keywords-plus: 'INFLAMMATORY RESPONSE SYNDROME; WARNING SYSTEM; IMPLEMENTATION;

  BARRIERS; MORTALITY; CRITERIA; OUTCOMES; IMPROVE; SEPSIS; EWS'
language: English
month: APR 26
number: '1'
number-of-cited-references: '50'
papis_id: ad7c99957940742ad1d87e68e2a54a21
ref: Slezak2022screeninginfectious
times-cited: '1'
title: 'Screening for infectious maternal morbidity-knowledge, attitudes and perceptions
  among healthcare providers and managers in Malawi: a qualitative study'
type: Article
unique-id: WOS:000787760200003
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '22'
web-of-science-categories: Obstetrics \& Gynecology
year: '2022'