Knowledge, Attitudes and Practices of Sepsis Diagnosis, Stratification and Management Among Healthcare Providers at The University Teaching Hospitals (UTH), Lusaka, Zambia.

Sepsis is a medical emergency caused by a dysregulated host response to infection. Early diagnosis and initiation of optimal treatment is fundamental for management. Globally, about 11 million deaths (19·7%) are sepsis-related. In sub-Sahara Africa, in-hospital mortality due to severe sepsis is 39%. Limited resources in Low-middle income countries (LMICs) hinder the decline in sepsis-related mortalities. The University Teaching Hospitals (UTH), the largest tertiary hospital in Zambia, has paucity of information about sepsis management. This study explored healthcare providers’ knowledge, attitudes and practices concerning sepsis at the UTH to inform policy and sepsis guidelines formulation. 

An online survey was conducted in 2020, and Stata/BE version 17 software was used for data analysis. 

59 respondents were enrolled. 48(81.4%) were either junior resident medical officers (JRMO) or registrar with 30(50.9%) having less than five years of working experience. 56(91.8%) were unaware of the sepsis risk stratification tool. Overall knowledge score among respondents was 44.8 (standard deviation [SD]=28.3). Consultants’ score was 37.9 (SD=27.0), JRMO 38.9 (SD=28.5) and registrars 57.6(SD=23.6). 46 (78.0%) correctly identified the most appropriate rehydration fluid used for a septic patient. Conversely, only 11(18.6%) correctly identified the lactate threshold indicative of sepsis. A significant difference with questions relating to lactate threshold, indicative of sepsis was observed (p=0.011). Overall attitude score was 55.1 (SD=37.5) and 39(66.1%), reported often using non-invasive BP monitoring, while 27(45.8%) reported the frequent monitoring of oxygen saturations when attending to septic patients. Overall practice score was 44.9 (SD=30.5) and 43(72.9%) reported often checking equipment for monitoring patient vitals in their departments, with the least 11(18.6%) reporting conducting monitoring activities of septic patients in their departments. There was significant difference between participants regarding monitoring activities of septic patients in their respective departments (p=0.029).  

Studies have shown implementation of local-tailored and cost-effective sepsis measures to improve outcomes in LMICs. UTH has high influx of patients in the emergency department, thus implementation of standardized sepsis guidelines and formulation of local cost-effective protocols will help healthcare providers correctly identify and effectively manage patients with high risk of deteriorating. The identified multilevel barriers to quality-care provision should be addressed appropriately.