Disease burden of maternal sepsis and maternal infections in low- and middle-income countries from 1990 to 2023 and projections to 2035: An analysis based on the global burden of disease study

BACKGROUND: Maternal sepsis and maternal infections (MSMI) are significant causes of maternal mortality in low- and middle-income countries (LMICs). This study, leveraging data from the Global Burden of Disease Study 2023 (GBD 2023), intended to evaluate the trends in the disease burden of MSMI in LMICs from 1990 to 2023, along with its inequality characteristics and future trends. METHODS: Based on the GBD 2023 database, data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates of MSMI in 129 LMICs from 1990 to 2023 were extracted. Joinpoint regression, decomposition analysis, and health inequality analysis were employed to evaluate changes in disease burden and their driving factors. An autoregressive integrated moving average (ARIMA) model was established to predict trends in disease burden from 2024 to 2035. RESULTS: From 1990 to 2023, the relative burden of MSMI in LMICs generally declined, and the most pronounced decrease was observed in the DALYs rate (estimated annual percentage change (estimated annual percentage change (EAPC) = -3.11, 95% confidence interval (CI): -3.26 to -2.95). However, the absolute burden showed a divergent trend. Specifically, the number of incident cases and prevalent cases increased by 24% and 33%, respectively, while the number of deaths and DALYs decreased by 37% and 39%, respectively. Stratified analysis uncovered that the burden worsened in low-income (gross national income (GNI)-L) countries (with incident cases and prevalent cases rising by 126% and 109%, respectively), whereas decreases were more significant in upper-middle-income (GNI-UM) countries (with deaths and DALYs decreasing by 83% and 81%, respectively). The increased burden in GNI-L countries was primarily driven by population growth, with relative contributions to the incidence burden and prevalence burden of 121.6% and 136.5%, respectively. In addition, widening health inequalities were observed. The concentration indexes for the DALYs rate and mortality rate decreased from -0.392 to -0.594 and from -0.395 to -0.603, respectively. ARIMA projections indicated that while the mortality rate was expected to continue to decline from 2024 to 2035 (with an average annual decrease of -6.4%), the decrease in the incidence rate was projected to be limited (with an average annual decrease of -0.82%). CONCLUSION: Over the past three decades, while the overall burden of MSMI in LMICs has decreased, the control of its absolute burden remains insufficient. GNI-L countries continue to bear a higher burden and experience widening health inequalities. Future prevention and control efforts should not only focus on continuously reducing the overall burden but also prioritize targeted resource allocation for GNI-L countries. Moreover, equity should be integrated into routine monitoring and evaluation systems.