A landmark multi-country clinical trial has shown that a structured, sustainable approach to infection prevention and treatment can save women's lives, cutting severe maternal infections and deaths by about one-third (32%) compared to usual care. The maternal programme of prevention and treatment (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 among the leading causes of maternal death worldwide. Every 30 minutes a mother dies from a sepsis-related cause somewhere in the world, with the greatest burden borne by women in low and income countries. The Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) intervention tackles this challenge through an integrated programme focused on three areas: improving hand hygiene, strengthening infection prevention and management, and enhancing sepsis care with the FAST-M sepsis bundle.
The trial, conducted across 59 hospitals in Malawi and Uganda and involving more than 430,000 women, assessed whether structured improvements in infection prevention, early recognition, and timely treatment of maternal sepsis could save lives. Findings from the trial show that even within a very resource-limited environment this innovative approach made it possible to support healthcare workers to improve maternal outcomes and can be sustained in resource-limited health systems.
The study report revealed that the APT-Sepsis intervention not only reduced the incidence of maternal infection-related mortality or severe morbidity by 32%, but that the program was equally effective in both Uganda and Malawi. The effectiveness was sustained over time, increasing steadily from the first month of the intervention to the final month, when a 47% reduction was achieved.
The programme 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. With a 32% reduction in infection-related maternal deaths and life-threatening complications, this programme has the potential to transform care. Policymakers now have compelling evidence to scale up these interventions so that fewer women die from preventable infections during pregnancy and childbirth."
Jeremy Farrar, Assistant Director-General, WHO, said: "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. We must ensure these life-saving practices are scaled and sustained across all settings."
Henry Mwandumba, Programme Director at the Malawi Liverpool Wellcome Research Programe, MLW, said: "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 and reflects the dedication of our team and partners, and look forward to seeing how this intervention pioneered in Malawi can be scaled-up to help mothers worldwide"
Fungaro Lydia, Midwife and APT Champion at Arua Regional Referral Hospital, Uganda said: "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."
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 - and without relying on costly additional resources - APT-Sepsis is designed to offer a low-cost, sustainable and rapidly scalable model for national and international health programmes seeking to improve maternal survival globally.
The trial was managed by the Department of Womens and Childrens Health and the Liverpool Clinical Trials Centre at the University of Liverpool and the Malawi-Liverpool-Wellcome Research Programme, Malawi and Infectious Diseases Institute, Uganda.
The work of Professor David Lissauer and Professor Catriona Waitt (University of Liverpool and the Infectious Diseases Institute, Makerere University) is supported by NIHR Global Health Research Professorships. 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 study is published in the New England Journal of Medicine (NEJM).
