Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh

Aboud, Frances E.; Rahman, Ehsanur; Kassam, Rosemin; Khan, Jasmin; Ali, Nabeel Ashraf; Taleb, Fahmida

doi:10.1016/j.socscimed.2017.01.032

Cited by 3 publications

(14 citation statements)

References 20 publications

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“…Long health itinerary: hospital admission > 3 days after fever onset [64] Home care: administration of medicines that were still available at home, either remaining from prior illness or bought and stored at home in advance to illness [10] Healthcare seeking: any care sought from an external healthcare provider (briefly referred to as provider) [9] Delayed first healthcare seeking: first healthcare seeking > 1 day after fever onset [7,8,41,65] Formal healthcare seeking: healthcare seeking at registered health posts, health centres or hospital. These providers were grouped as formal healthcare providers [9,10,36,37].…”

Section: Study Populationmentioning

confidence: 99%

“…Two thirds of deaths occurred during the first 2 days of admission and the total number of children who arrived dead at the hospital or died before enrolment (n = 51) was almost equal to the total number of deaths in enrolled children (n = 57). Although some of these children might have been saved with good resuscitation practices, earlier presentation at the hospital is essential to allow prompt appropriate treatment and to reduce case fatality [8].…”

Section: Long Health Itinerary and High Case Fatality In Children Wit...mentioning

confidence: 99%

“…Starting appropriate treatment of severe febrile illness within 24 to 48 hours is crucial to avoid progression to life-threatening sepsis and requires hospital admission [7][8][9] and thus reduces mortality [8,9]. Unfortunately, in low-resource settings, delayed and inappropriate healthcare seeking and prehospital patient management, together with transport difficulties, delay appropriate treatment and are associated with in-hospital death [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…For children with severe febrile illness and children with bloodstream infections in particular, data are scarce. It is however in this population that appropriate treatment is most urgent and requires early referral, as is stressed by the high mortality during the first 48 hours of sepsis treatment [5,8,12].…”

Section: Introductionmentioning

confidence: 99%

“…In this hospital-based study, we assessed the health itinerary of children under-five with severe febrile illness. Delaying factors were identified according to the Three Delays framework, which describes delays related to healthcare seeking, reaching the healthcare provider and prehospital appropriate patient management [8,11]. Next, we aimed to identify delaying factors associated with in-hospital death for prioritization during health education and health system reforms.…”

Section: Introductionmentioning

confidence: 99%

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Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Tack

Vita²,

Nketo³

et al. 2023

PLoS Negl Trop Dis

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Background Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. Methodology Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (>28 days − <5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. Principal findings From 784 enrolled children, 36.1% were admitted >3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. Conclusions Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. Trial registration NCT04289688

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Section: Study Populationmentioning

confidence: 99%

Section: Long Health Itinerary and High Case Fatality In Children Wit...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Tack

Vita²,

Nketo³

et al. 2023

PLoS Negl Trop Dis

View full text Add to dashboard Cite

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Exploration of pre‐hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study

et al. 2022

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Aim We explored patient pre‐hospital delays in seeking care for symptoms of bacteremia and sepsis. Design A qualitative descriptive study. Methods In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi‐structured interviews by telephone. The tape‐recorded interviews were transcribed, coded and analysed using the Common‐Sense Model of Self‐Regulation. Data analysis continued until May 2021. Results The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help‐seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co‐morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient‐reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.

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Identifying barriers and facilitators to seeking care for symptoms of bacterial sepsis: A qualitative study

Ruffin,

Van Horn,

Kennedy‐Malone

et al. 2023

Nursing Open

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AimResearch suggests that early access to quality care is essential to improving bacteraemia outcomes and reducing the risk of developing sepsis because it allows for early intervention. Currently, there are limited data regarding the facilitators and barriers that alter the trajectory of arrival at the hospital when patients in the United States experience symptoms of bacteraemia and sepsis. This study sought to explore and describe the facilitators and barriers to seeking care for suspected bacteraemia and sepsis symptoms.DesignA qualitative descriptive study.MethodsTen men and women were recruited using convenience sampling. The study used audio‐recorded semi‐structured interviews and the collection of socio‐demographic data as the data collection techniques. Thematic analysis was used, including inductive and deductive approaches, to analyse the data.ResultsDuring data analysis, the codes related to barriers and facilitators were collapsed into three themes—symptom recognition, psychosocial support and healthcare planning and coordination.Patient ContributionThe patients' participation in the study has contributed to our understanding of patients' perspectives and experiences in the pre‐hospital phase and provides important insights into what barriers and facilitators are encountered. Study findings highlight the need to develop interventions to improve patient decision time, patient–provider interactions and knowledge of bacteraemia and sepsis through patient and provider education.

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Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh

Cited by 3 publications

References 20 publications

Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Exploration of pre‐hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study

Identifying barriers and facilitators to seeking care for symptoms of bacterial sepsis: A qualitative study

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