Sepsis in Northern Tanzania: A Prospective Observational Study of Clinical Characteristics, Management, and Outcomes for Adolescents and Adults With Sepsis

Abstract

Background. Despite a high burden of sepsis in Sub-Saharan Africa, clinical data for adolescent and adult sepsis in this setting are limited. We sought to describe clinical characteristics, management, and outcomes in adolescents and adults with sepsis in northern Tanzania. We also assessed for clinical associations with in-hospital mortality. Methods. We conducted a prospective observational cohort study at Kilimanjaro Christian Medical Centre in Moshi, Tanzania, 2019–2020. Data were collected on demographics, clinical characteristics, and management primarily from hours 0–6 after arrival at the emergency department. We calculated bivariable risk ratios (RRs) for associations between demographic and clinical factors and in-hospital death. A multivariable-adjusted analysis was performed for associations between antimicrobial and intravenous fluid administration and in-hospital death. Results. Of 86 participants with sepsis, 25 (29.1%) died in the hospital. Baseline characteristics associated with in-hospital mortality included inability to drink unassisted (RR, 3.15; 95% CI, 1.58–6.30), altered mentation (RR, 3.94; 95% CI, 2.12–7.33), quick Sequential Organ Failure Assessment (qSOFA) score ≥2 (RR, 2.86; 95% CI, 1.42–5.72), and Universal Vital Assessment score ≥5 (RR, 6.33; 95% CI, 2.36–17.02). Twenty-nine (33.7%) received an antimicrobial by hour 6. HIV antibody testing was performed for 4 (4.7%) participants by hour 6. On multivariable analysis, neither antimicrobial administration nor intravenous fluids >1L by hour 6 was associated with in-hospital mortality. Conclusions. Sepsis at our center in northern Tanzania carried a high risk of in-hospital mortality. Further research is needed to establish the highest-yield interventions suited to the unique characteristics of sepsis in Sub-Saharan Africa.