Sepsis Recognition And Management In Africa
The acute syndrome resulting from malfunctioning organs because of a deregulated immunity in response to infections defines the term sepsis. Systemic inflammatory response syndrome (SIRS) is often used interchangeably with sepsis such that SIRS can result from both non-immune and immune triggers unlike sepsis which results only from immune triggers.
Rello, Valenzuela-Sanchez, Ruiz-Rodriquez & Moyano, 2017 state that sepsis consists of two phases, the first being the initial hyper inflammatory phase that is characterized by SIRS and the second one which is the subsequent immunosuppressive phase characterized by organ malfunction, known as CARS (compensatory anti-inflammatory response syndrome).Septic shock is a subset of sepsis in which the underlying circulatory and metabolic or cellular abnormalities significantly increase mortality. Sepsis detection is difficult because the indicative signs are non-specific.
There are limited reports in Africa on the concept of sepsis that entail its epidemiology, management and outcomes thereof. Awareness is also not rampant. The prevalence of sepsis in Africa is likely to account for a significant proportion of the global burden of sepsis. This statement is supported by statistics that reveal the majority of around 300 million deaths worldwide occur in Africa. Hence, the incidence of sepsis in Africa is by far the most. Otherwise, 8 million are due to sepsis globally.
Sepsis death cases are not truthfully reported. This is particularly due to frequent misdiagnosing by healthcare professionals, their failure to report the occurrence of sepsis in clinical notes, the non-recognition of sepsis as a cause of death by the World Health Organization (WHO) Global Burden of Disease Report (GBDR) – the warehouse of information necessary in health decision making. The coding aspect of sepsis is also challenging as the proposed guidelines are difficult to use in under-resourced and -developed healthcare institutions.
Despite grueling efforts, sepsis remains an issue in clinical medicine. Previous hospital record analysis show that the incidence increases every year. Studies have made a conclusion that severe sepsis is common, expensive and fatal. It is different from other diagnosis in that its survival rate is based on a 28-day period unlike other mortality cases that are based on a 5-year survival period.
Sepsis remains a difficult disease to treat with a mortality rate as high as 70%. Few new therapies have been developed in the field of sepsis to this date with the mainstay treatment being non-specific supportive care. Several drugs were tested on the basis of in vitro and animal models but have proved to be ineffective in humans – sepsis is notorious for that and is named the “graveyard” of pharmaceutical therapy. The current understanding of sepsis is inadequate due to the few therapies developed since its research debut.
Rello, et al., 2017 also state that due to inadequate understanding of sepsis, diagnosis is made on the basis of biomarker combinations since the pathophysiology is even complex on its own. Wenzel & Edmon, 2015 add on by stating the need for improvement in source control and safer antibiotics for limiting microbial growth. Because there is inadequate understanding on the matter, the conclusions of many articles recommend and suggest improvements and strategies in the field of sepsis. Coelho & Martins, 2012 mention that a gold standard test for sepsis is still searched for in order to provide sepsis treatment with enough efficiency in the future. They also stress that, “health is so precious, knowledge must rise to meet current needs”, which makes valid sense.
Meanwhile, in Africa, little evidence concerning the early recognition and management of sepsis in sub-Saharan Africa. Complex bundles of care developed in higher-income countries to sub-Saharan Africa have shown no benefit. More depth should be made in the research of how to come up with a universal guideline for sepsis treatment. Greater attention should be made to the current epidemiology of developing and developed countries as they differ. Early therapeutic interventions is not uniformly practiced and delays prompt treatment of sepsis, avoiding death as the end result.
