Why sepsis remains the hidden danger in maternal and child healthcare

Last year the National Family Health Survey (NFHS-5) data was rolled out. Initial glitches notwithstanding, data was collected across half the states and several important aspects of household profiles were comprehensively presented, including marriage and fertility, family planning services, maternal and child health, delivery care, child immunisation, treatment of childhood diseases, nutrition and feeding practices, anaemia, diabetes , hypertension and cancer examination. It reflects the state of health of the nation and highlights the many maternal and child health interventions undertaken across states.

However I was surprised to see very little research on the state of maternal and neonatal sepsis in India. Sepsis rates have an overall impact on maternal and neonatal mortality, and combating it will save lives and directly contribute to the achievement of SDG 3 (Sustainable Development Goals). But the true burden of maternal and neonatal sepsis is unknown, owing to lack of accurate data. A complete overhaul is needed to identify and address the multidimensional aspects of sepsis in maternal and child health.

India and the sepsis rate

We need to “investigate” each case of sepsis to find out why and from where it was triggered. Currently there is no investigation of the cause of sepsis and it is accepted as and when it happens. Few know that every 11 women per 1,000 live births had an infection which resulted in or contributed to what is known as a severe maternal outcome — either they died or nearly died — during their hospitalisation. Similarly, when it comes to neonatal sepsis, most infants in our country need to be monitored for the high-risk factors. Residual neurologic damage occurs in 15–30 per cent of neonates with septic meningitis. Any sepsis should be taken seriously and lessons should be learnt on the source of the infection and how to avoid it. Newborn screening should be made mandatory for timely detection of sepsis cases.

The way forward

In developing countries like India, where the major hurdle to intervention is poverty, maternal mortality due to sepsis represents maternal health inequality. We need urgent steps to counter this life-threatening risk faced by all pregnant and recently pregnant women. Currently there’s not enough research to gauge the rate at which sepsis is occurring. India needs effective solutions for sepsis and its management — a life threatening complication of an infection — which may have a high burden in the country. While the rising worldwide burden of sepsis prompted the World Health Organization (WHO) in 2017 to declare sepsis a global health priority, India has meagre data on the medical condition. A close analysis of data shows that the sepsis rates do not vary greatly between NFHS-4 and NFHS-5. Have we tried to understand the reasons for this?

In a country like India, maternal infections during pregnancy and childbirth are a leading cause of preventable death in both the mother and child. It is important for decision makers to know how common these infections are, so that efforts are made to prevent them. The ongoing pandemic heightens the importance of hygiene, handwashing and masks, which are measures to keep infection away, but we also need accountability and transparency because every death from suspected sepsis should be investigated for the causes and the ways to prevent it. We need to take metabolic screening to all corners of the country — a measure that is already overdue by a few decades.

The writer is Founder Chairman and Neonatologist, Cloudnine Group of Hospitals, Bengaluru