A groundbreaking multi-country clinical trial has demonstrated that a structured, sustainable approach to infection prevention and treatment can significantly save women’s lives. The study revealed a reduction in severe maternal infections and deaths by approximately one-third (32%) compared to standard care. This maternal health initiative, known as the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis), was developed by researchers at the University of Liverpool, the World Health Organization (WHO), and the UN’s Special Programme in Human Reproduction (HRP).
Maternal infection and sepsis remain leading causes of maternal mortality worldwide, with a mother dying from a sepsis-related cause every 30 minutes. The burden is particularly heavy in low-income countries. The APT-Sepsis intervention addresses this challenge through an integrated program focused on improving hand hygiene, strengthening infection prevention and management, and enhancing sepsis care with the FAST-M sepsis bundle.
Trial Outcomes and Impact
The trial was conducted across 59 hospitals in Malawi and Uganda, involving more than 430,000 women. It assessed whether structured improvements in infection prevention, early recognition, and timely treatment of maternal sepsis could save lives. The findings indicate that even in resource-limited environments, this innovative approach supports healthcare workers in improving maternal outcomes and can be sustained in such health systems.
The study report highlighted that the APT-Sepsis intervention reduced the incidence of maternal infection-related mortality or severe morbidity by 32%, with consistent effectiveness in both Uganda and Malawi. The program’s effectiveness increased over time, culminating in a 47% reduction by the final month of the trial.
Expert Insights and Reactions
The program supported healthcare providers to:
- Improve compliance with hand-hygiene standards.
- Adopt evidence-based practices for infection prevention and management.
- Detect sepsis early and deliver treatment using the FAST-M bundle (fluids, antibiotics, source control, transfer if required, and monitoring).
Professor David Lissauer, NIHR Professor of Global Maternal and Fetal Health at the University of Liverpool, said: “These results are hugely significant. For too long, maternal sepsis has been a leading but neglected cause of preventable maternal deaths worldwide. Our findings demonstrate that APT-Sepsis provides a practical, sustainable, and effective solution.”
Jeremy Farrar, Assistant Director-General, WHO, commented: “The APT-Sepsis programme is a testament to what can be achieved when science, policy, and frontline care come together. Reducing maternal infections and deaths by over 30% is not just a clinical success – it’s a call to action for global health systems to prioritise infection prevention in maternal care.”
Voices from the Field
Fungaro Lydia, a midwife and APT Champion at Arua Regional Referral Hospital, Uganda, expressed gratitude for the intervention: “I want to thank APT-Sepsis for coming to our rescue. Previously, we had no reliable way of monitoring mothers. We used to do things in our own way, but now, with the intervention, we can detect danger early.”
Henry Mwandumba, Programme Director at the Malawi Liverpool Wellcome Research Programme, MLW, stated: “We are immensely proud that MLW contributed to a project that has delivered such a significant reduction in maternal infections and deaths. This is a testament to our commitment to improving the health and wellbeing of women in Malawi.”
Implications and Future Directions
The trial demonstrates that structured, system-level interventions can overcome long-standing barriers such as inconsistent adherence to infection-prevention practices and delays in the recognition and treatment of sepsis. By embedding improved practices within existing health systems, APT-Sepsis offers a low-cost, sustainable, and rapidly scalable model for national and international health programs seeking to improve maternal survival globally.
The trial was managed by the Department of Women’s and Children’s Health and the Liverpool Clinical Trials Centre at the University of Liverpool, along with the Malawi-Liverpool-Wellcome Research Programme and the Infectious Diseases Institute, Makerere University, Uganda. This work was funded by the UK Medical Research Council (MRC), the National Institute for Health and Care Research (NIHR), UK AID, the UK Foreign, Commonwealth and Development Office, and MSD for Mothers through the Joint Global Health Trials Scheme.
The efforts of Professor David Lissauer and Professor Catriona Waitt (University of Liverpool and the Infectious Diseases Institute, Makerere University) are supported by NIHR Global Health Research Professorships. The success of APT-Sepsis underscores the potential for similar interventions to be scaled up globally, reducing preventable maternal deaths and transforming maternal care.
