Introduction to Antimicrobial Resistance and the Maternal Sepsis Intervention

This chapter describes the threat to global health and security caused by the growing resistance of infectious organisms to antibiotics or antimicrobial resistance (AMR). Growing global connectivity ensures that AMR is a threat to us all wherever we are and with specific impacts on Low- and Middle-Income Countries (LMICs). The chapter outlines international responses to AMR including the Global Action Plan and the impact this has had on one LMIC; Uganda. It then introduces a recent UK funding call focused on improving the management of antibiotics or ‘Antimicrobial Stewardship’.

Infection Prevention Control (IPC) and Antimicrobial Resistance (AMR)

This chapter outlines a key component of improved AMR; namely infection prevention control (IPC). It addresses some of the issues most commonly associated with IPC including hand hygiene, waste disposal and infrastructure. It then addresses wound management as an Infection Control issue. The emergence of wound management as a central focus in the Maternal Sepsis Intervention proved pivotal in shaping the pathway to antimicrobial stewardship.

Change Processes: Multi-Disciplinary Teamwork

This chapter examines the importance of multi-disciplinary team-working to the management of antimicrobial stewardship and behaviour change processes. MDT has played a major role in improving communication and reducing professional boundaries that had previously contributed to high levels of infection; extended use of, often inappropriate antibiotics and poor patient outcomes. The functioning of such teams facilitates the role of clinical pharmacy.

The Impact of the Maternal Sepsis Intervention

This chapter presents data on maternal mortality in Uganda and the contribution that sepsis makes to mortality. Against this backdrop, it identifies key outcomes of the intervention including major improvements in maternal mortality and reductions in the length of patient stays, readmission rates and hospital expenditure.

The Role of Microbiology Testing in Controlling Infection and Promoting Antimicrobial Stewardship

This chapter discusses the Role of Microbiology Testing in Controlling Infection and Promoting Antimicrobial Stewardship. It details the role that culture and sensitivity testing has played in creating the ‘objective’ evidence base that facilitated and nurtured midwifery empowerment, task shifting and multi-disciplinary team working. The chapter presents findings of resistance patterns of isolates from women with suspected sepsis.

Task Shifting, Midwifery Empowerment and the Nascence of Clinical Pharmacy

This chapter addresses the role that the intervention has played in shaping professional engagement within the multi-disciplinary team. The existence of laboratory results has triggered the emergence of clinical pharmacy roles. The chapter traces the impact of this on prescribing behaviour and on procurement planning and hospital policies. Whilst celebrating the progress made and viability of the model, it describes the structural impact that access to antibiotics and IPC supplies has on the realisation of optimal change.

Conclusions: Capturing, Sustaining, Spreading and Researching Change

This chapter summarises the overall impacts of the Maternal Sepsis Intervention reflecting on the processes of capturing, sustaining and spreading best practice in antimicrobial stewardship. It argues that sustainability is achievable when an intervention reduces hospital costs and, in such cases, the responsibility or sustainability rests with LMIC institutions. Key barriers to sustainability include supply chain weaknesses and human resource limitations. The chapter recommends the use of Public–Private Partnerships to help to overcome these barriers.

Autonomy, Evidence and Methods in Global Health

This chapter discusses the growing impact that funding bodies have on the design, delivery and evaluation of global health interventions with specific emphasis on the UK’s Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) funding programme. It explains the reasons for focusing the antimicrobial resistance intervention on maternal sepsis and describes the context within which the Maternal Sepsis Intervention took place; in a Regional Referral Hospital in Western Uganda.

The Knowledge Creation and Transfer Mechanism

This chapter reflects on the relationship between the knowledge mobilisation processes that have contributed to behaviour change at an individual and organisational level. It critiques the traditional emphasis in international development on one-off, formal, foreign-led ‘training’ episodes and contrasts these with the more fluid, bilateral, approach to learning through co-working and mentoring.