In 2015, in the tiny African country of Rwanda, one of the poorest countries in the world, lower respiratory tract infection caused more premature deaths and disability than any other disease. Of the top 10 diseases that caused death and disability in Rwanda, five were infectious diseases.
These numbers, unfortunately, are not uncommon. Consider that, across the globe, approximately 90% of deaths caused by infections occur in low- or middle-income countries. Many of these deaths result from sepsis, the body’s overwhelming and life-threatening response to infection.
To try to combat these statistics the Surviving Sepsis Campaign (SSC), a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine committed to reducing mortality and morbidity from sepsis and septic shock worldwide, launched the Sepsis in Resource-Limited Nations project in 2017.
The results of this project, as well as sepsis research priorities for the future, as identified by the SSC Research Committee, were published in Critical Care Medicine in August 2018.
“Sepsis is one of the leading causes of premature death in low and lower- to middle-income countries,” said Martin W Dünser, MD, PD, co-leader of the Sepsis in Resource-Limited Nations project, professor of anesthesiology at Johannes Kepler University Linz in Austria, and SCCM past president. “Our working group hypothesized that, by improving and optimizing care of acute infectious diseases, progression to sepsis, organ failure, and death can be prevented.”
This hypothesis was put to the test in Gitwe, Rwanda, in collaboration with the Gitwe District Hospital and the surrounding community. The goal was “to evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections.”
Gitwe Hospital, with 200 beds and one emergency department, serves a population of approximately 160,000 people. There are no intensive care or highdependency services available. During site visits, Dr. Dünser; J. Christopher Farmer, MD, FCCM, the project’s co-leader; and their team evaluated the local epidemiology of acute infections and the capacity of the hospital and its referring healthcare centers.
The researchers decided to try to educate local healthcare providers on how to screen for and treat patients with sepsis to improve mortality rates for this deadly condition. The first step was to teach local researchers how to enter information into a database. These data were analyzed to learn more about the local patient population and, specifically, who was getting sepsis and why. Data analysis revealed that the average patient with sepsis in Rwanda was only 8 years old.
With this new knowledge, the project leads collaborated with local medical personnel to create materials and programs to educate healthcare providers on how to best identify and treat patients. Part of this education involved understanding how to identify early stages of sepsis and determining at which point interventions are likely to be most effective.
“Simple interventions that are both feasible and available, even in resource-limited settings, could help to reduce the excessive burden of infection and sepsis in the poorest regions of the world,” Dr. Dünser said.
The final stage of the project was to equip these healthcare providers with sepsis kits that contained basic supplies for sepsis intervention. The kits included hydration fluids and tools for measuring blood pressure and temperature. Some kits also had a wide variety of antibiotics. Oxygen concentrators were provided to Gitwe Hospital’s emergency department, so that oxygen could be administered to patients.
During the project, 7,326 people were screened for sepsis. Of these, more than 1 in 5 people qualified for intervention.
While the goal of the Sepsis in Resource-Limited Nations project was to reduce mortality caused by sepsis, the reality is that little infrastructure, dirt roads, and few ambulances continue to make healthcare in Rwanda challenging. This is why the researchers and volunteers involved with the project were focused on empowering local clinicians to identify the signs of sepsis and treat it as quickly as possible. The hope is that this education and empowerment will result in the healthcare providers’ long-term success and a greater reduction in deaths from sepsis
SCCM was recently recognized for its work in Rwanda by the Center for Association Leadership with the prestigious Power of A Gold Award. This award is presented to associations that leverage their unique resources to solve problems, advance industry/professional performance, kickstart innovation, and improve world conditions.
SCCM is currently investigating the possibility of expanding the Sepsis in Resource-Limited Nations project to Uganda.
Its goal is to have the Rwanda project serve as a model to improve care in other resource-limited nations. To learn more about the Surviving Sepsis Campaign, visit SurvivingSepsis.org.