Challenges in the Management of Sepsis in a Resource-Poor Setting

Abstract

Background: Sepsis is a deleterious host reaction to microorganism and can lead to high mortality rate. Early recognition and prompt treatment increases the chances of survival. Objective: To outline the challenges in the management of sepsis in a resource limited setting and make appropriate recommendations. Methodology: The data was collected through an online literature search for cases of sepsis managed in resource limited settings from 1990 to 2015. Search terms used included: “sepsis”, “septicaemia”, “incidence”, “prevalence”, “morbidity”, “mortality” and “management challenges” using the English and American spellings. Studies from peer reviewed journals or those presented in professional conferences were selected. Finally, studies with proper definition of sepsis and positive blood cultures were selected. Result: Twenty one studies from eleven resource limited settings were found. A total of 14,862 cases of sepsis were studied with 9260 (62.3%) of neonatal sepsis and 5602 (37.7%) of post neonatal sepsis. Challenges in the management of sepsis that were identified at the community level included: false cultural beliefs and practices, ignorance and poverty, poor health seeking behavior, late presentation, lack of access to skilled care and patronage of unskilled medical practitioners. While challenges identified at the hospital level include: poor knowledge skills of the health workers, delay in making a diagnosis and initiating treatment, poorly equipped laboratory materials and personnel, no protocol for management of sepsis, limited supply of bedside monitoring equipment, poor staffing, repeated industrial actions, use of fake drugs and high cost of care and drugs. Conclusion and recommendation: Management of sepsis in resource limited settings is an uphill task and requires health education and re-orientation of the people. To significantly reduce the mortality associated with sepsis, there is a need to bring health care services to the communities where the people are, improve the management skills of health professionals and translate major components of sepsis management to resource limited settings.