The FAST‐M complex intervention for the detection and management of maternal sepsis in low‐resource settings: a multi‐site evaluation

Research output: Contribution to journalArticlepeer-review


  • James Cheshire
  • Laura Munthali
  • Christopher Kamphinga
  • Harry Liyaya
  • Tarcizius Phiri
  • William Parry‐Smith
  • Catherine Dunlop
  • Charles Makwenda
  • Bejoy Nambiar
  • Abi Merriel
  • Helen Williams
  • Amie Wilson
  • David Lissauer

External organisations

  • Parent and Child Health Initiative (PACHI) Trust Lilongwe Malawi
  • University of Liverpool
  • University College London Hospitals NHS Foundation Trust
  • University of Bristol


Objective: To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting. Design: A before-and-after design. Setting: Fifteen government healthcare facilities in Malawi. Population: Women suspected of having maternal sepsis. Methods: The FAST-M complex intervention consisted of the following components: the FAST-M maternal sepsis treatment bundle and the FAST-M implementation programme. Performance of selected process outcomes was compared between a 2-month baseline phase and 6-month intervention phase with compliance used as a proxy measure of feasibility. Main outcome result: Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle. Results: Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis. Conclusion: Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi. Tweetable Abstract: Implementation of a sepsis care bundle for low-resources improved recognition & management of maternal sepsis.

Bibliographic note

Funding Information: Research funding was provided by MSD for Mothers, University of Birmingham and the charity Ammalife. Funds from MSD were provided through its MSD for Mothers programme. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, N J, USA. DL, AC, JC, AW and CD all work as volunteers with the charity Ammalife. Those engaged in the work were excluded from the funding decision made by Ammalife. None of the funders had input into the study design, data collection, data analysis, data interpretation or writing of the report.


Original languageEnglish
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Early online date4 Feb 2021
Publication statusE-pub ahead of print - 4 Feb 2021


  • Care bundle, complex intervention, feasibility study, low-resource setting, maternal sepsis

ASJC Scopus subject areas