Contextualising international guidelines on sepsis management: A case study of Lambaréné, Gabon
2 juillet 2021
Author: Lomuthando Nthakomwa
©Jake Greenberg/U.S. Navy

Sepsis, a life-threatening disease that causes organ dysfunction, is the cause of at least eleven million deaths worldwide every year—with Sub-Saharan Africa being the most susceptible. Having such a significant death rate, it is of great concern that there still exists a knowledge gap regarding sepsis among health workers in Lambaréné, Gabon.

Sepsis cannot be effectively managed where knowledge is lacking, as it requires early detection and prompt treatment. As such, many sepsis-related deaths could be easily avoided by ensuring that health workers are provided with information on the disease, its detection, and treatment.

While the knowledge gap is concerning, the lack of localised guidelines regarding the disease worsens the situation, as this want of policy directly affects how sepsis is detected and managed.

What does the research show?
AFIDEP, through the African Research Collaboration on Sepsis (ARCS) project, is at the forefront of contributing to evidence in preventing and treating sepsis. As such, Paul Kawale (Research and Policy Associate at AFIDEP) alongside counterparts, conducted a study between February and June 2020 assessing health workers’ understanding of sepsis in Lambaréné, Gabon. This is one of the few studies that exists which focusses on  developing countries, and probably the first from Sub-Saharan Africa. The health workers that participated in this study were physicians, nurses and assistant nurses; and were representative of all health facilities in Lambaréné.

The study found, unexpectedly, that there exists a significant knowledge gap about sepsis amongst health workers. Many were not even aware of the changing definitions of the disease, with less than half (48.7%) of the surveyed health workers correctly stating that ‘sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.’ Nevertheless, the majority of health workers were able to state some of the signs of sepsis, as well as what procedures and drugs are needed to effectively manage the disease.

While the study’s findings highlight the knowledge gap, it is of no surprise as there have been no recent specific trainings or educational activities related to sepsis for health workers in Lambaréné.  Gabon, like many other developing countries, also does not have any national guidelines for the management of the disease, and therefore relies on international guidelines, which are not always directly contextually applicable.  Health practitioners are thus left to manage sepsis using a case-by-case approach based on personal experience, knowledge, training, and whatever medication and equipment are at their disposal.

What needs to be done?
To lessen the knowledge gap on sepsis in Gabon and other developing countries, and have a more uniform and informed treatment approach, policymakers need to rework international guidelines to fit national contexts. This, however, can only be successful where a consultative approach with local stakeholders is followed and local ownership of the developed policies is taken up. Further to this, future guardians of the guidelines (district or provincial health offices) the future implementers of the guidelines (community health workers and health service providers); and future beneficiaries of the guidelines (community members) need to also fully attest to them to ensure their successful use.

Sepsis is a serious health threat to Africa, and the world at large. While this study focused on Lambaréné, there still exists a need to go further by surveying health workers across Gabon so as to increase awareness on the disease, subsequently improving detection and treatment efforts.

To access the full paper: Knowledge of health workers relating to sepsis awareness and management in Lambaréné, Gabon – African Institute for Development Policy – AFIDEP

On World Sepsis Day 2021, AFIDEP‘s Dr. Paul Kawale discussed some of the studies recently published on sepsis in both Malawi and Gabon. The interview was conducted by Youth Net and Counselling (YONECO) FM . Listen to an excerpt of the interview here:

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.

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