The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis.

Ben Morton,Kevin Mortimer,Marie Stolbrink,Jamie Rylance,Wanjiku Kagima

doi:10.3390/ijerph15092017

Abstract

Sepsis is a common cause of morbidity and mortality in sub-Saharan African adults. Standardised management pathways have been documented to improve the survival of adults with sepsis from high-resource settings. Our aim was to assess the current evidence base for early sepsis interventions (recognition, empirical antibiotics, and resuscitation) in resource-poor settings of sub-Saharan Africa. We searched MEDLINE, EMBASE and CINHAL Plus databases to identify interventional studies for the early recognition and management of sepsis in sub-Saharan Africa (1 January 2000 to 1 August 2018) using a protocol-driven search strategy: adults, protocolised care pathway, and sub-Saharan Africa. We identified 725 publications of which three met criteria for final selection. Meta-analysis from two randomised controlled trials demonstrated that mortality was increased by ‘early goal-directed therapy’ interventions that increased fluid resuscitation (R.R. 1.26, 95% C.I. 1.00–1.58, p = 0.045; I2 53%). The third observational cohort study demonstrated improved survival after implementation of protocolised management for sepsis (mortality 33.0% vs. 45.7%, p = 0.005). No study incorporated standardised protocols for empirical antibiotic administration. High rates of pneumonia and mycobacteraemia were reported. There has been little research into the early recognition and management of sepsis in sub-Saharan Africa. Interventional trials of early goal-directed therapy have, to date, increased mortality. There is an urgent need to develop effective strategies to improve outcomes for adults with sepsis in sub-Saharan Africa.

Highlights

Sepsis—‘life threatening organ dysfunction caused by a dysregulated host response to infection’—affects approximately 30 million people around the world every year [1,2]
In addition to the three studies included in the data synthesis (Table 1), we identified several key studies that addressed isolated components of sepsis management or were non-interventional in design
These studies fall outside of our selection criteria, they are summarised in Table 2 as they provide additional insights into sepsis management in sub-Saharan Africa

Summary

Introduction

Sepsis—‘life threatening organ dysfunction caused by a dysregulated host response to infection’—affects approximately 30 million people around the world every year [1,2]. People in low- to middle-income (LMIC) areas of the world—and sub-Saharan Africa—suffer disproportionately high mortality compared to those from high-income countries (HIC) [3]. The Surviving Sepsis Campaign (SSC Guidelines) [4] has promoted standardised early recognition and management of sepsis and led to improved patient outcomes in high-income countries [5]. The principles of early recognition, empirical antibiotics and fluid resuscitation set out in the SSC. Guidelines have been adopted into sepsis management components of the World Health Organization. Res. Public Health 2018, 15, 2017; doi:10.3390/ijerph15092017 www.mdpi.com/journal/ijerph

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