ArticlePloS one2022
Emergency care of sepsis in sub-Saharan Africa: Mortality and non-physician clinician management of sepsis in rural Uganda from 2010 to 2019.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sepsis screening tools in resource-limited settings: a systematic review and meta-analysis of diagnostic accuracy in low- and middle-income countries.Frontiers in public health · 2026Pooled it
- Approximating Molecular Sepsis Subtypes Using Bedside Data in Resource-Limited Settings: A Multicenter Analysis From Uganda.Critical care explorations · 2026Observational
- Assessment of Bedside-Adaptable Models to Predict Molecular Sepsis Subtypes in a Resource-Limited Setting: A Multicenter Analysis from Uganda.medRxiv : the preprint server for health sciences · 2026Article
- Supportive care and in-hospital mortality among children with suspected sepsis in Bamako, Mali.Frontiers in pediatrics · 2026Article
- The regulatory mechanism of NLRP3 inflammasome in the "immune paralytic-overactivation" imbalance in sepsis: the latest progress from molecular signaling to clinical translation.Frontiers in immunology · 2026Review
- Identification of transcriptomic sepsis endotypes in sub-Saharan Africa: derivation, validation, and global alignment in two Ugandan cohorts.Intensive care medicine · 2025Observational
- Differences in quality indicators of emergency care between on- and off-hours at Ghanaian district hospitals.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2025Article
- Perceptions, availability and use of vasopressors for septic shock in emergency care settings in Tanzania.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2025Article
- Applying the three delays qualitative model to sepsis care seeking and emergency care in a private hospital in Lagos, Nigeria.BMC health services research · 2025Article
- Unsupervised Classification of the Host Response Identifies Dominant Pathobiological Signatures of Sepsis in Sub-Saharan Africa.American journal of respiratory and critical care medicine · 2025Article
- Article
- Predictors of mortality for perforated peptic ulcer disease in Malawi.American journal of surgery · 2023Article
- Clinical emergency care quality indicators in Africa: a scoping review and data summary.BMJ open · 2023Article
- Persistence is key: unresolved immune dysfunction is lethal in both COVID-19 and non-COVID-19 sepsis.Frontiers in immunology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionLittle data exists from sub-Saharan Africa describing incidence and outcomes of sepsis in emergency units and uncertainty exists surrounding optimal management of sepsis in low-income settings. There exists limited data regarding quality care metrics for non-physician clinicians trained in emergency care. The objective of this study was to describe changes in septic patients over time and evaluate associations between sepsis care and mortality.
methodsSecondary analysis of a prospective cohort of all consecutive patients seen from 2010-2019 in a rural Ugandan emergency unit staffed by non-physician clinicians was performed using an electronic database based on paper charts. Sepsis was defined as suspected infection with a quick Sequential Organ Failure Assessment score (qSOFA)≥1. Multi-variable logistic regression was used to analyze three-day mortality.
resultsOverall, 48,653 patient visits from 2010-2019 yielded 17,490 encounters for patients age≥18 who had suspected infection, including 10,437 with sepsis. The annual proportion of patients with sepsis decreased from 45.0%% to 21.3% and the proportion with malarial sepsis decreased from 17.7% to 2.1% during the study period. Rates of septic patients receiving quality care ("both fluids and anti-infectives") increased over time (21.2% in 2012 to 32.0% in 2019, p<0.001), but mortality did not significantly improve (4.5% in 2012 to 6.4% in 2019, p = 0.50). The increasing quality of non-physician clinician care was not associated with reduced mortality, and treatment with "both fluids and antibiotics" was associated with increased mortality (RR = 1.55, 95%CI 1.10-2.00).
conclusionThe largest study of sepsis management and outcomes ever published in both Uganda and sub-Saharan Africa showed sepsis and malarial sepsis decreasing from 2010 to 2019. The increasing quality of non-physician clinician care did not significantly reduce mortality and treatment with "both fluids and antibiotics" increased mortality. With causal associations between antibiotics and mortality deemed implausible, associations between sepsis mortality and interventions likely represent confounding by indication. Defining optimal sepsis care regionally will likely require randomized controlled trials.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.