title: The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan.
abstract: BACKGROUND
  Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk.
  
  
  METHODS
  The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics.
  
  
  CONCLUSIONS
  This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. linda.bartlett@jhu.edu.
authors.forename: L A
authors.initials: LA
authors.lastname: Bartlett
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. alefevre@jhsph.edu.
authors.forename: A E
authors.initials: AE
authors.lastname: LeFevre
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. fatima.mir@aku.edu.
authors.forename: F
authors.initials: F
authors.lastname: Mir
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. sajid.soofi@aku.edu.
authors.forename: S
authors.initials: S
authors.lastname: Soofi
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. shabina.ariff@aku.edu.
authors.forename: S
authors.initials: S
authors.lastname: Arif
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. dmitra1@jhu.edu.
authors.forename: D K
authors.initials: DK
authors.lastname: Mitra
authors.affiliation: Centre for Reproductive Health, icddr,b, Dhaka, Bangladesh. aquaiyum@icddrb.org.
authors.forename: M A
authors.initials: MA
authors.lastname: Quaiyum
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. sadia.shakoor@aku.edu.
authors.forename: S
authors.initials: S
authors.lastname: Shakoor
authors.affiliation: Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh. msohag10@yahoo.com.
authors.forename: M S
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh. connorne@icddrb.org.
authors.forename: N E
authors.initials: NE
authors.lastname: Connor
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. pwinch@jhu.edu.
authors.forename: P J
authors.initials: PJ
authors.lastname: Winch
authors.affiliation: Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. mreller1@jhmi.edu.
authors.forename: M E
authors.initials: ME
authors.lastname: Reller
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. mshah34@jhu.edu.
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.affiliation: Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh. shams@icddrb.org.
authors.forename: S
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. abaqui@jhsph.edu.
authors.forename: A H
authors.initials: AH
authors.lastname: Baqui
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@aku.edu.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. anita.zaidi@aku.edu.
authors.forename: A
authors.initials: A
authors.lastname: Zaidi
authors.affiliation: Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh. samirk.sks@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. sahmed3@jhu.edu.
authors.forename: S A
authors.initials: SA
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D058345:Asymptomatic Infections / Q000453:epidemiology; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D003150:Community Health Workers; D065246:Culturally Competent Care / Q000208:ethnology; D003906:Developing Countries; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D006792:House Calls; D006801:Humans; D015994:Incidence; D058889:Molecular Typing; D010154:Pakistan / Q000453:epidemiology; D049590:Postpartum Period; D011645:Puerperal Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents