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. 2021 Oct 18;21(1):1074.
doi: 10.1186/s12879-021-06779-0.

The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Liyuan Chen  1 , Qi Wang  2 , Yun Gao  3 , Jinxiang Zhang  4 , Sheng Cheng  5 , Huilong Chen  6 , Zhilin Zeng  6 , Zhongxian Wang  7
Affiliations

The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Liyuan Chen et al. BMC Infect Dis. .

Abstract

Background: Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women's and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures.

Methods: Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters.

Results: Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions.

Conclusion: These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

Keywords: Death; Disability-adjusted life year; Global burden disease; Incidence; Maternal mortality ratio; Maternal sepsis and other maternal infections.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential competing interests.

Figures

Fig. 1
Fig. 1
The burden and trends of MSMI globally from 1990 to 2019. A The change of incident cases. B The change of death number. C The change of DALY. D The change of ASIR per 100,000 population. E The change of ASDR per 100,000 population. F The change of age-standardized DALY rate per 100,000 population. The black triangle represent value in corresponding year and shading shows 95% uncertainty intervals. Note: MSMI maternal sepsis and other maternal infections; DALY disability-adjusted life-years; ASIR age-standardized incident rate; ASDR age-standardized death rate
Fig. 2
Fig. 2
The burden and trends of MSMI worldwide in different ages in the past 30 years A The change of incident cases. B The change of death number. C The change of DALY. D The change of ASIR per 100,000 population. E The change of ASDR per 100,000 population. F The change of age-standardized DALY rate per 100,000 population. Note: MSMI maternal sepsis and other maternal infections; DALY disability-adjusted life-years; ASIR age-standardized incident rate; ASDR age-standardized death rate
Fig. 3
Fig. 3
The burden and trends of MSMI in five SDI quintiles globally from 1990 to 2019. A The change of incident cases. B The change of death number. C The change of DALY. D The change of ASIR. E The change of ASDR. F The change of age-standardized DALY rate. Note: MSMI maternal sepsis and other maternal infections; SDI sociodemographic index; ASIR age-standardized incident rate per 100,000 population; ASDR age-standardized death rate per 100,000 population; DALY disability-adjusted life-years per 100,000 population
Fig. 4
Fig. 4
The age-standardized rate of MSMI in 204 countries and territories in 2019. A The ASIR of MSMI globally in 2019. B The ASDR of MSMI globally in 2019. C The age-standardized DALY rate of MSMI globally in 2019. Note: MSMI maternal sepsis and other maternal infections; ASR age-standardized rate; ASIR age-standardized incident rate per 100,000 population; ASDR age-standardized death rate per 100,000 population; DALY disability-adjusted life-years per 100,000 population
Fig. 5
Fig. 5
The EAPC of MSMI in 204 countries and territories in the last three decades. A The EAPC of ASIR per 100,000 population in the last three decades. B The EAPC of ASDR per 100,000 population. C The EAPC of age-standardized DALY rate per 100,000 population. Note: MSMI maternal sepsis and other maternal infections; EAPC annual percentage change; ASIR age-standardized incident rate per 100,000 population; ASDR age-standardized death rate per 100,000 population; DALY disability-adjusted life-years per 100,000 population
Fig. 6
Fig. 6
The MMR of MSMI across the world in the last 30 years. A The change of MMR in all age from 1990 to 2019. B The change of MMR in different age groups. C The change of MMR in five SDI regions in 2019. D The MMR of MSMI globally per 100,000 livebirths in 2019. E The EAPC of MMR. The black triangle represent value in corresponding year and shading shows 95% uncertainty intervals. Note: MSMI maternal sepsis and other maternal infections; MMR number of maternal deaths per 100,000 livebirths; EAPC annual percentage change
Fig. 7
Fig. 7
The correlation between the SDI and both ASR and MMR of MSMI in 2019. The SDI negatively correlated to the ASIR (A), ASDR (B), age-standardized DALY rate (C) and MMR (D) in 2019. Note: MSMI maternal sepsis and other maternal infections; MMR number of maternal deaths per 100,000 livebirths; ASIR age-standardized incident rate per 100,000 population; ASDR age-standardized death rate per 100,000 population; DALY disability-adjusted life-years per 100,000 population
Fig. 8
Fig. 8
The correlation analyses between SDI and ASR or MMR of MSMI in 21 regions from 1990 to 2019. The SDI negatively correlated with the ASIR (A), ASDR (B), age-standardized DALY rate (C) and MMR (D) in 21 regions from 1990 to 2019. Note: MSMI maternal sepsis and other maternal infections; ASIR age-standardized incident rate per 100,000 population; ASDR age-standardized death rate per 100,000 population; DALY disability-adjusted life-years per 100,000 population; MMR number of maternal deaths per 100,000 livebirths
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