The Global Burden of Sepsis: World Sepsis Day, September 13
World Sepsis Day – September 13th, 2014
This is a guest post by:
Niranjan Kissoon, MBBS, FRCP(C), FAAP, FCCM, FACPE
UBC & BC Children’s
Hospital Professor in Critical Care – Global Child Health
Department of Pediatrics and Emergency Medicine, UBC
Sepsis is the leading killer of children worldwide, but this is not reflected in estimates of global mortality. For instance, the Global Burden of Disease study, a systematic analysis of global and regional mortality report “sepsis and infectious disorders of the newborn” representing 17% of neonatal deaths; however another 15% of neonatal deaths due to infections are not identified as death due to sepsis although sepsis is the final common pathway to death. The term “sepsis” is also excluded in the under 5 childhood deaths although 61% of deaths are due to infectious causes of which malaria (20.8%), diarrheal diseases (11.9%) and lower respiratory infections (12.4%) are the most common.
That severe infections leads to sepsis or severe sepsis and septic shock is supported by clinical and robust pathophysiologic evidence. From the clinician’s standpoint, the three most common causes of death (pneumonia, malaria and diarrheal diseases) in children often co-exist and any or all, when severe, lead to sepsis and septic shock. While it is important to classify deaths according to specific causes, we contend that it is a mistake to ignore the unifying feature of all of these deaths – that they are due to sepsis. The issue of highlighting sepsis as the end result of severe infections is not merely cosmetic but is important for a provision of care especially in resource limited environments where skilled healthcare workers are in short supply and care is being delivered by teams with limited training and clinical skills. The failure to highlight the syndrome of sepsis, regardless of the infecting organism(s), as a major killer and public health issue is an oversight with serious implications for the clinician because the most important interventions to reduce sepsis morbidity and mortality must be made generically and before a definitive diagnosis is available. Thus, calling attention to the need for time-sensitive treatment in severe infections is unlikely to happen if severe infections are compartmentalized in separate silos such as malaria, pneumonia and diarrheal diseases.
Sepsis has clinical, social, economic and political origins and implications as highlighted by the ongoing Ebola outbreak in West Africa. Care for sepsis especially in the developing world is plagued by delays in recognition and in many cases basic care and personal protective procedures are not followed. Sepsis is also a social and economic problem in the developing world where lack of education and money, faith and supernatural causes and home remedies complicates care. Long distances and non availability of transport as well as many stops and long waiting time leads to lack of faith in the health care system. In addition, lack of empowerment of women in many parts of the world results in poor health seeking care behavior for their children. In many parts of the developing world there are also low emphasis on preventative services, staff shortages and inequity of health care and poorly regulated managed health care sectors.
Thus the adoption of a broader concept to highlight the burden and far reaching implications of sepsis is paramount for advocacy for resources to support innovative programs. This was the impetus for the creation of the World Sepsis Declaration and subsequently World Sepsis Day. The intent of World Sepsis Day was two-fold: First, to raise awareness of sepsis among all stakeholders including members of the public and policy makers and second, to encourage capacity building and quality improvement initiatives for sepsis recognition and management by hospitals and health care providers toward delivering the goals set out in the World Sepsis Declaration (www.world-sepsis-day.org).
These goals are:
- Reducing sepsis incidence through prevention by at least 20 percent
- Improving survival for children and adults in all countries
- Raising public and professional awareness and understanding of sepsis
- Ensuring improved access to adequate rehabilitation services
- Creating and maintaining sepsis incidence and outcomes databases.
You can take action and help to increase the awareness and participate in education about sepsis. You can also support the World Sepsis Declaration by registering on the World Sepsis Day website http://www.world-sepsis-day.org/ and speak out about sepsis and support our request to get sepsis on the agenda of the United Nations. You can also help by educating the public about sepsis prevention measures and long term outcomes, educating administrators about the issues of sepsis in your own organization, participating in many events and seminars about sepsis that are gaining ground for medical professions in many parts of the world. Engage government agencies to enable them to recognize sepsis as a national health topic and join in the global movie event which will focus on collecting video material to create a compelling informative movie about World Sepsis Day 2014.
We would appreciate if you inform us of your activities and help make World Sepsis Day a success.