Perceptions, availability and use of vasopressors for septic shock in emergency care settings in Tanzania.

Background: Sepsis carries a disproportionately high mortality in Sub-Saharan Africa. Current international guidelines for management of septic shock advocate for initial fluid resuscitation followed by vasopressors if there is ongoing concern for hypoperfusion. Emerging data suggest patients in sub-Saharan Africa who receives large fluid boluses may have increased mortality and thus earlier initiation of vasopressors may have clinical benefit. Little data exists on the perceptions, availability and use of vasopressors in Tanzania, which may impact the feasibility of this strategy. We aimed to describe the perception, availability and use of vasopressor in Tanzanian emergency care settings, including its barriers. Methods: We conducted a cross-sectional web-based survey among clinicians and nurses from 19 different hospitals throughout Tanzania (national, zonal, regional and district hospitals). Collected data was kept by the principal investigator on a password encrypted computer whereby descriptive statistics were used to summarize the results. Results: Sixty-five healthcare providers completed the survey of whom the majority 53 (81.5 %), work in the emergency medicine department and 50 (76.9 %) reported treating at least one patient with septic shock per week. However, three quarters of respondents from district hospitals and nearly half of those from regional hospitals had access to vasopressors in <50 % of the time. The most common reported barriers to vasopressor use were lack of availability (50.8 %), and lack of comfort or knowledge (43.1 %). Overall, most respondents perceived that vasopressor use is generally safe and helpful for treating septic shock. Conclusions: Nearly all Tanzanian healthcare providers in emergency care settings reported that they had limited access to vasopressors to treat septic shock, as it was not consistently available. In addition to unavailability, lack of knowledge on vasopressor use was also reported as barrier. Our findings suggest that ensuring availability of vasopressors and education in the use thereof would improve sepsis care in Tanzanian hospitals.