Validation of community health worker identification of maternal puerperal sepsis using a clinical diagnostic algorithm in Bangladesh and Pakistan

Puerperal sepsis (PP sepsis) is a leading cause of maternal mortality globally. The majority of maternal sepsis cases and deaths occur at home and remain undiagnosed and under-reported. In this paper, we present findings from a nested case-control study in Bangladesh and Pakistan which sought to ass...

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Vydáno v:	Journal of global health Ročník 11; s. 04039
Hlavní autoři:	LeFevre, Amnesty E, Mir, Fatima, Mitra, Dipak K, Ariff, Shabina, Mohan, Diwakar, Ahmed, Imran, Sultana, Shazia, Winch, Peter J, Shakoor, Sadia, Connor, Nicholas E, Islam, Mohammad Shahidul, El-Arifeen, Shams, Quaiyum, MA, Baqui, Abdullah H, Gravett, Michael G, Santosham, Mathuram, Bhutta, Zulfiqar A, Zaidi, Anita, Saha, Samir K, Ahmed, Saifuddin, Soofi, Sajid, Bartlett, Linda A, Ahmed, Saifuddin D, el-Arifeen, Shams, Begum, Nasma, Bhutta, Zulfiqar, Connor, Nicolas E, Hirani, Farzeen, Hotwani, Aneeta, Islam, MS, Khan, Imran, LeFevre, Amnesty E., Mahmud, Arif, Mitra, Dipak K., Moin, Syed Mamun, Qureshi, Shahida, Rafiqullah, Iftekhar, Reller, Megan E, Roy, Arun Dhutta, Wasan, Yaqub
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Scotland Edinburgh University Global Health Society 01.01.2021 International Society of Global Health
Témata:	Abdomen Algorithms Bangladesh Biopsy Case-Control Studies Child Community Health Workers Female Fever Global health Health facilities Hospitals Humans Identification Illnesses Infections Literature reviews Maternal mortality Medical diagnosis Medical personnel Medical referrals Morbidity Pain Pakistan Physicians Postpartum Period Pregnancy Pregnancy Complications, Infectious Reproducibility of Results Sepsis Sepsis - diagnosis Systematic review Uterus Vagina Womens health Bangladesh Pakistan Karachi Pakistan South Asia
ISSN:	2047-2978, 2047-2986, 2047-2986
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Shrnutí:	Puerperal sepsis (PP sepsis) is a leading cause of maternal mortality globally. The majority of maternal sepsis cases and deaths occur at home and remain undiagnosed and under-reported. In this paper, we present findings from a nested case-control study in Bangladesh and Pakistan which sought to assess the validity of community health worker (CHW) identification of PP sepsis using a clinical diagnostic algorithm with physician assessment and classification used as the gold standard. Up to 300 postpartum women were enrolled in each of the 3 sites 1) Sylhet, Bangladesh (n = 278), 2) Karachi, Pakistan (n = 278) and 3) Matiari, Pakistan (n = 300). Index cases were women with suspected PP Sepsis as diagnosed by CHWs clinical assessment of one or more of the following signs and symptoms: temperature (recorded fever ≥38.1°C, reported history of fever, lower abdominal or pelvic pain, and abnormal or foul-smelling discharge. Each case was matched with 3 control women who were diagnosed by CHWs to have no infection. Cases and controls were assessed by trained physicians using the same algorithm implemented by the CHWs. Using physician assessment as the gold standard, Kappa statistics for reliability and diagnostic validity (sensitivity and specificity) are presented with 95% CI. Sensitivity and specificity were adjusted for verification bias. The adjusted sensitivity and specificity of CHW identification of PP sepsis across all sites was 82% (Karachi: 78%, Matiari: 78%, Sylhet: 95%) and 90% (Karachi: 95%, Matiari: 85%, Sylhet: 90%) respectively. CHW-Physician agreement was highest for moderate and high fever (range across sites: K = 0.84-0.97) and lowest for lower abdominal pain (K = 0.30-0.34). The clinical signs and symptoms for other conditions were reported infrequently, however, the CHW-physician agreement was high for all symptoms except severe headache/ blurred vision (K = 0.13-0.38) and reported "lower abdominal pain without fever" (K = 0.39-0.57). In all sites, CHWs with limited training were able to identify signs and symptoms and to classify cases of PP sepsis with high validity. Integrating postpartum infection screening into existing community-based platforms and post-natal visits is a promising strategy to monitor women for PP sepsis - improving delivery of cohesive maternal and child health care in low resource settings.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Equal contribution.
ISSN:	2047-2978 2047-2986 2047-2986
DOI:	10.7189/jogh.11.04039