Sepsis is the second biggest cause of death in the world and the leading cause of preventable death. Globally, there are an estimated 30 million cases of sepsis each year, with over 7 million ending in death. Of these deaths, at least 2 million are estimated to occur in Africa. Despite being a major killer, sepsis remains largely unknown by the general public and health care workers, and is under-prioritised by policy-makers.
From 14th – 16th June 2019, experts converged in Dar es Salaam under the African Research Collaboration on Sepsis (ARCS) initiative to discuss sepsis in Malawi, Gabon and Uganda and the need to highlight sepsis as a policy issue.The meeting saw experts identify three inter-related problems confronting sepsis in these countries.
First is the need for a standardised definition for sepsis. There are many different definitions of sepsis, even among doctors and experts, and this makes it difficult for most people to fully understand and engage with sepsis. Consequently, there is limited to no population awareness of it. Even amongst medical practitioners, there is only a presumptive diagnosis of sepsis and no point-of-care tests. As a result, practitioners put less emphasis on sepsis but rather look at other diseases associated with it, leading to the second issue of lack of data availability due to the syndromic (and not objective) diagnosis of sepsis. This is compounded by the fact that there is no public budget or private funding for sepsis research in Africa, so it is generally not prioritised. This vicious circle is completed by there being no resources for sepsis-related training or treatment and the third problem: lack of population awareness. There is no word for sepsis in vernacular, and consequently no social chatter in communities about sepsis, which would aid in engaging discussion and building pressure for government intervention. There is also no pressure on the government from the medical profession, who consider it as “small fish” secondary to “real” underlying problems associated with sepsis, such as malaria, TB or HIV.
Based on this, participants embarked on the policy-influencing objective of generating more knowledge to recognise sepsis as a priority disease and put it on the agenda. Specifically, there is a need to converge the problem with policy and politics by engaging with eleven stakeholder groups, namely: Civil Society Organisations, Ministries of Health (MoH), Laboratory personnel, Media, Health recorders, International funders, Researchers, Medical teachers, Clinicians, Ethics committees, and Regulatory bodies.
These stakeholders should be engaged in four low-cost outcome mapping approaches:
With sepsis having human and financial costs, these approaches could bring sepsis on the policy agenda, where it needs to be, by converging the problem with policy and politics. Re-shaping the perception of sepsis among key stakeholders and making it a policy issue is vital to reducing cases in Africa, and the world at large. This World Sepsis Day, let us play our part and spread awareness.
ARCS is a Global Health Research Group awarded by the National Institute for Health Research (NIHR grant reference number 17/63/42) and led by the Liverpool School of Tropical Medicine (LSTM). This blog presents independent research funded by the NIHR. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.