The global burden of sepsis: barriers and potential solutions

Abstract

Sepsis is a major contributor to the global burden of disease. The majority of sepsis cases and deaths are estimated to occur in low and middle-income countries. Barriers to reducing the global burden of sepsis include difficulty quantifying attributable morbidity and mortality, low awareness, poverty and health inequity, and under-resourced and low-resilience public health and acute health care delivery systems. Important differences in the populations at risk, infecting pathogens, and clinical capacity to manage sepsis in high and low-resource settings necessitate context-specific approaches to this significant problem. We review these challenges and propose strategies to overcome them. These strategies include strengthening health systems, accurately identifying and quantifying sepsis cases, conducting inclusive research, establishing data-driven and context-specific management guidelines, promoting creative clinical interventions, and advocacy.

Keywords: Health resources; Low-income countries; Poverty; Public health; Sepsis.

Fig. 1

Burden of sepsis highlights public health and acute health care delivery system challenges. ICU intensive care unit, PICU pediatric intensive care unit

Fig. 2

Annual health expenditure per capita in high-income countries (HICs) versus low or middle-income countries (LMICs). The 2014 health expenditure per capita from World Bank’s DataBank Health, Nutrition, and Population Statistics database [23]

Fig. 3

Sepsis trials are predominantly conducted in high-income countries. ClinicalTrials.gov and www.anzctr.org.au were searched on July 21, 2018 using search terminology “sepsis” in search terms and problem studied, study type “interventional”, and recruitment status “recruiting” or “enrolling by invitation”. Of 62 countries with any open interventional sepsis trial, 34 (55%) are classified as high-income economies by The World Bank