The burden of sepsis and severe infections in low- and middle-income countries (LMICs) has been difficult to assess due to a paucity of data. It is estimated that there is a global annual incidence of up to 31 million cases of sepsis and 6 million fatalities, but these numbers are based on imputations of data from high-income countries (HIC). Early clinical recognition of sepsis is essential for improving patient outcomes, and the development of tools to help clinicians identify sepsis is a top research priority. Existing sepsis tools for adults and children were developed and research in HIC settings, and adaptation of these tools in LMIC settings are not well-studied. Prior to the COVID-19 pandemic, we studied the burden of sepsis among adults and children presenting to the largest public hospital in Belize and found that sepsis was significantly under-diagnosed, and there was a higher mortality in patients with sepsis in the emergency department. We aim to build on this previous work and partnerships by developing tools for physicians and nurses to identify and initiate early treatment for adult and pediatric patients with sepsis.
This project will take place at the Karl Heusner Memorial Hospital Authority in Belize City. It serves as the district hospital, covering a population of 131,000, as well as the national referral center. The Accident and Emergency Department (A&E) has a patient volume of approximately 25,000 visits annually, one-third of which are pediatric, and the hospital has emergency medicine, critical care, and pediatric specialists. From a previous study, over 10% of patients were transferred from other Belizean hospitals for further care. We believe this is the best place to implement this project due to the multi-disciplinary team already in place, availability of specialized services for patients with sepsis, and the potential to develop tools that can be used in other emergency departments in Belize and LMIC settings.
We expect to decrease mortality for patients with sepsis with the use of tools to aid physicians and nurses in early identification and treatment. We also hope to see a decrease in emergency department and hospital length of stays. This project’s impact will continue past this trip with the shared leadership with Belizean physicians and nurses as well as continued monitoring and integration of sepsis tools in the emergency care system.
We worked alongside Belizean physicians in the Emergency and COVID units of the referral hospital taking care of patients and reinforcing best practices in emergency care. We shared our experiences of working with patients with sepsis at a symposium with over 60 physician participants from around the country.