The early recognition and management of sepsis in sub-Saharan African adults: A systematic review and meta-analysis

Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854, Stolbrink, Marie ORCID: https://orcid.org/0000-0001-6091-9316, Kagima, Wanjiku ORCID: https://orcid.org/0000-0003-2470-569X, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611 and Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871 (2018) 'The early recognition and management of sepsis in sub-Saharan African adults: A systematic review and meta-analysis'. International Journal of Environmental Research and Public Health, Vol 15, Issue 9.

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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 (1st January 2000 to 1st 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.

Item Type:	Article
Additional Information:	This article belongs to the Special Issue Lung Health, Tuberculosis, and Air Pollution in Low- and Middle-Income Countries
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 240 Bacteremia. Sepsis. Toxemias WF Respiratory System > WF 140 Diseases of the respiratory system (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.3390/ijerph15092017
Depositing User:	Stacy Murtagh
Date Deposited:	19 Sep 2018 09:40
Last Modified:	13 Mar 2020 16:19
URI:	https://archive.lstmed.ac.uk/id/eprint/9307

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