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Rethinking Paediatric Sepsis Care through Local Provider Voices and Lived Systems: A Mixed-Methods Study in Two
Charles Martyn-Dickens1,2, Sheila Agyeiwaa Owusu3,4,5, Allysa Warling6
1Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Insights
Paediatric sepsis care in Ghana requires context-specific adaptations, as global protocols face challenges in resource-limited settings. Interventions co-designed with local input are crucial for improving outcomes and strengthening health systems.
Area of Science:
- Global Health
- Paediatric Infectious Diseases
- Health Systems Research
Background:
- Paediatric sepsis is a leading cause of mortality in low- and middle-income countries (LMICs).
- Existing global sepsis protocols, effective in high-income settings, may not be suitable for resource-constrained LMIC contexts.
- Implementation challenges exist for standardized sepsis bundles in resource-limited settings.
Purpose of the Study:
- To investigate the factors influencing paediatric sepsis care in Ghana.
- To identify barriers and facilitators to effective sepsis management in resource-limited hospitals.
- To inform the development of contextually appropriate sepsis care strategies.
Main Methods:
- A mixed-methods study was conducted in two Ghanaian hospitals (Komfo Anokye Teaching Hospital and Presbyterian Hospital, Agogo).
- Methods included a retrospective chart review of paediatric sepsis cases and key informant interviews with clinical staff.
- Qualitative data analysis utilized the Three Delays Framework and the Donabedian Model.
Main Results:
- Seventy-one patient charts were reviewed, revealing inconsistencies in documentation and care processes.
- Despite differences in patient severity, mortality rates were similar across the two study sites.
- Interviews highlighted provider dedication and community support, alongside systemic delays due to financial and resource constraints.
Conclusions:
- Paediatric sepsis care in Ghana is shaped by interconnected structural, cultural, and procedural factors.
- Contextually adapted care pathways are essential for improving sepsis outcomes in resource-limited settings.
- Co-designed interventions, rather than solely imported protocols, offer a sustainable approach to strengthening health systems in LMICs.
Background:
Paediatric sepsis remains a significant cause of mortality in low- and middle-income countries (LMICs), where health systems are often resource-constrained. Global sepsis protocols, though effective in high-income settings, may not be well-suited to LMIC contexts.
Methods:
We conducted a mixed-methods study in two hospitals in the Ashanti Region of Ghana: Komfo Anokye Teaching Hospital (KATH) and Presbyterian Hospital, Agogo (PreHA). Specifically, we conducted a retrospective chart review, followed by key informant interviews with clinical staff, and integrated our findings with a previously published situational analysis. Qualitative data analysis employed the Three Delays Framework and the Donabedian Model to identify locations and causes of delays in care.
Results:
Seventy-one charts met the inclusion criteria for review, having a history of fever or hypothermia and complete vital signs documented (16 from PreHA, 55 from KATH). Despite KATH managing more severely ill patients with higher sepsis scores and longer stays, mortality rates were similar at both sites. The chart review highlighted gaps in documentation and inconsistent care processes. Key informant interviews revealed themes such as provider altruism, community financial support, and the positive role of research collaborations, while also illustrating systemic delays linked to financial and resource constraints.
Conclusion:
Paediatric sepsis care in Ghana is influenced by complex and interconnected structural, cultural, and procedural factors. Our findings indicate that contextually adapted care pathways are crucial for improving sepsis outcomes in resource-constrained settings. Co-designed interventions, rather than wholly imported protocols, may offer a more sustainable approach to strengthening health systems in LMICs.
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