A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria.

Odiraa C Nwankwor,Brianna Mckelvie,Meg Frizzola,Krystal Hunter,Halima S Kabara,Niranjan Kissoon,Tagbo Oguonu,Abiola Oduwole

doi:10.3389/fped.2019.00234

Abstract

Background: Infections leading to sepsis are major contributors to mortality and morbidity in children world-wide. Determining the capacity of pediatric hospitals in Nigeria to manage sepsis establishes an important baseline for quality-improvement interventions and resource allocations.Objectives: To assess the availability and functionality of resources and manpower for early detection and prompt management of sepsis in children at tertiary pediatric centers in Nigeria.Methods: This was an online survey of tertiary pediatric hospitals in Nigeria using a modified survey tool designed by the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS). The survey addressed all aspects of pediatric sepsis identification, management, barriers and readiness.Results: While majority of the hospitals 97% (28/29) reported having adequate triage systems, only 60% (16/27) follow some form of guideline for sepsis management. There was no consensus national guideline for management of pediatric sepsis. Over 50% of the respondents identified deficit in parental education, poor access to healthcare services, failure to diagnose sepsis at referring institutions, lack of medical equipment and lack of a definitive protocol for managing pediatric sepsis, as significant barriers.Conclusions: Certain sepsis-related interventions were reportedly widespread, however, there is no standardized sepsis protocol, and majority of the hospitals do not have pediatric intensive care units (PICU). These findings could guide quality improvement measures at institutional level, and healthcare policy/spending at the national level.

Highlights

Infections leading to sepsis is a major cause of pediatric morbidity and mortality globally, 80% of infectious disease-related deaths occur in low and middle income countries (LMICs) [1]
Children in LMICs are 18 times more likely to die under the age of five than children in higher income countries (HICs), a disparity caused by the interplay between economic, social and political factors and the inability to provide timely medical care partly due to resource limitations [2]
The disparity in resources is starkly revealed by the findings of a continent wide survey showing that the Surviving Sepsis Campaign (SSC) guidelines can be fully implemented in only 1.5% (4/263) of African ICUs [3]

Summary

Introduction

Infections leading to sepsis is a major cause of pediatric morbidity and mortality globally, 80% of infectious disease-related deaths occur in low and middle income countries (LMICs) [1]. The disparity in resources is starkly revealed by the findings of a continent wide survey showing that the Surviving Sepsis Campaign (SSC) guidelines can be fully implemented in only 1.5% (4/263) of African ICUs [3]. Recognition of this resource gap led the “Global Intensive Care Working Group” of the European Society of Intensive Care Medicine to adapt the SSC guidelines to LIMCs [4,5,6]. Determining the capacity of pediatric hospitals in Nigeria to manage sepsis establishes an important baseline for quality-improvement interventions and resource allocations

Objectives

Methods

Results

Conclusion