The Prevalence and Outcome of Sepsis in Critically Ill Patients in Malawi

Sepsis and septic shock are major contributors to global mortality, with disproportionately high rates in low- and middle-income countries. Sub-Saharan Africa faces challenges due to limited intensive care unit (ICU) capacity, delayed recognition, and scarce access to critical interventions. We evaluated the prevalence and outcomes of sepsis and septic shock among ICU patients at a tertiary hospital in Malawi.

We conducted a retrospective analysis of patients admitted to the ICU at Kamuzu Central Hospital in Lilongwe, Malawi. Sepsis was defined as a quick Sequential Organ Failure Assessment score ≥2, and septic shock was defined as a quick Sequential Organ Failure Assessment score ≥2 with vasopressor use. Cox regression and Kaplan-Meier analyses were performed to identify predictors of mortality and compare survival probabilities.

Of 499 ICU patients, 122 (24.4%) had sepsis, and 85 of these (69.7%) were in septic shock. Overall mortality was 56.5%, with septic patients experiencing significantly higher mortality than nonseptic patients (69.7% versus 52.3%, P = 0.003). In multivariable Cox regression, sepsis (hazard ratio 1.36, 95% confidence interval 1.02-1.82, P = 0.04) and septic shock (hazard ratio 3.23, 95% confidence interval 2.17-4.81, P < 0.001) were independently associated with an increased risk of death.

Sepsis and septic shock are prevalent among ICU patients in Malawi and are strongly associated with increased mortality. Strategies to improve outcomes should focus on early recognition, timely antibiotic administration, fluid resuscitation, and surgical source control in resource-limited settings.