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Effect of Maternal Sepsis Education on Maternal Sepsis Recognition among Healthcare Workers in Nigeria

Abstract

Maternal sepsis is a serious obstetric and public health condition that can rapidly progress to severe maternal illness, organ dysfunction, and death when it is not identified and treated promptly. Healthcare workers involved in antenatal, intrapartum, postpartum, emergency, and newborn care play an important role in the early recognition and management of maternal sepsis because timely identification of infection and clinical deterioration can facilitate prompt treatment and referral. Maternal sepsis education provides healthcare workers with knowledge and practical skills relating to the causes and risk factors of maternal sepsis, maternal infection, warning signs and symptoms, vital signs and clinical indicators, risk assessment, early identification of suspected cases, appropriate escalation of care, referral procedures, and relevant infection prevention and management protocols. Maternal sepsis recognition refers to healthcare workers' ability to identify signs, symptoms, risk factors, and clinical indicators suggestive of maternal sepsis and to recognize when urgent assessment, treatment, escalation, or referral is required. In Nigeria, inadequate maternal sepsis training, limited access to clinical guidelines, high workloads, staff shortages, delayed presentation of patients, inadequate diagnostic resources, and weak referral systems may affect the timely recognition of maternal sepsis. Effective maternal sepsis education may improve healthcare workers' knowledge, clinical recognition skills, risk awareness, and ability to identify women requiring urgent intervention. Against this background, this study investigates the effect of maternal sepsis education on maternal sepsis recognition among healthcare workers in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and the Knowledge-Attitude-Practice framework. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare workers' clinical behaviour. The Health Belief Model explains health-related behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding healthcare workers' recognition of maternal sepsis and response to clinical warning signs. The Knowledge-Attitude-Practice framework provides a basis for examining how structured maternal sepsis education may improve healthcare workers' knowledge and recognition practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal sepsis education may influence maternal sepsis recognition among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers involved in maternal healthcare services in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, maternal sepsis knowledge assessment, and clinical case-scenario recognition assessment. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, relevant clinical departments, and eligible healthcare workers. Where feasible, selected healthcare facilities or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured maternal sepsis education covering maternal sepsis risk factors, common sources of maternal infection, warning signs and symptoms, vital-sign abnormalities, clinical indicators of deterioration, early recognition, appropriate assessment, escalation of care, referral procedures, and relevant maternal sepsis prevention and management guidelines. Maternal sepsis recognition will be assessed using indicators such as identification of maternal infection, recognition of abnormal vital signs, identification of clinical deterioration, recognition of sepsis warning signs, interpretation of relevant clinical information, identification of women requiring urgent intervention, and selection of appropriate escalation or referral actions. Clinical case scenarios will be used where feasible to provide a more objective assessment of recognition ability. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, baseline maternal sepsis knowledge, exposure to education, and recognition scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of maternal sepsis education on maternal sepsis recognition. Where appropriate, pre-intervention and post-intervention recognition scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that maternal sepsis education has a significant positive effect on maternal sepsis recognition among healthcare workers in Nigeria. Healthcare workers exposed to structured maternal sepsis education are expected to demonstrate improved knowledge of maternal sepsis risk factors, warning signs, clinical indicators, and appropriate escalation procedures. Education may improve healthcare workers' ability to identify women with suspected maternal sepsis, recognize clinical deterioration, interpret abnormal vital signs, initiate timely escalation of care, and make appropriate referral decisions. Improved recognition may contribute to earlier intervention and potentially reduce delays in the management of maternal sepsis. However, education alone may not guarantee effective recognition and response in routine clinical settings because healthcare workers may continue to face barriers such as heavy workloads, staff shortages, inadequate diagnostic facilities, limited access to clinical guidelines, inadequate monitoring equipment, delayed laboratory results, and weak referral systems. Consequently, maternal sepsis education is expected to be most effective when supported by adequate staffing, appropriate monitoring equipment, accessible diagnostic services, clear clinical protocols, effective referral systems, regular supervision, and functional maternal emergency response systems. The study is expected to contribute to the literature on maternal sepsis, maternal health, obstetric emergency care, healthcare worker education, clinical recognition, maternal mortality prevention, health education, and public health in Nigeria by providing empirical evidence on the effect of maternal sepsis education on maternal sepsis recognition among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospital management authorities, maternal and reproductive health programmes, nursing and midwifery institutions, medical and nursing professional bodies, public health practitioners, development partners, and policymakers regarding strategies for improving early recognition of maternal sepsis. The study will also provide evidence-based recommendations for strengthening maternal sepsis education and continuing professional development, improving clinical recognition protocols, strengthening maternal emergency response systems, ensuring availability of appropriate monitoring and diagnostic equipment, improving referral pathways, and enhancing healthcare workers' capacity to identify and respond promptly to maternal sepsis in Nigeria.

Keywords: Maternal sepsis education, maternal sepsis recognition, healthcare workers, maternal sepsis, maternal health, obstetric emergencies, maternal mortality, clinical recognition, healthcare worker education, maternal emergency care, health education, public health, Nigeria.