Sub-Saharan Africa is disproportionately affected by the global burden of sepsis ¹. Limited well-characterized vital statistics data from Sub-Saharan Africa make it difficult to understand to what extent overall sepsis deaths are represented by deaths of patients who do not make it to the hospital.

Key to uncovering this knowledge gap is understanding health-seeking behavior and its interaction with other factors, including socioeconomic status, gender and access to transportation and health education. To address this gap, STAIRS will use a mixed-method approach leveraging existing health and demographic surveillance system (HDSS) sites and associated health facilities to collect prospective data from annual rounds, verbal autopsies, in-depth interviews and focus group discussions.

The burden of sepsis in sub-Saharan Africa is disproportionately high ^{1 2} and requires urgent and effective national and international action in all African countries to improve sepsis prevention, diagnosis, and clinical management ³.  According to available data, hospital mortality for sepsis in children and adults is high, and in some settings might be as high as 40% ^{4 5}. Across all partner sites, STAIRS will establish a multinational cohort of patients hospitalized with sepsis to characterize and compare clinical, microbiological and biochemical parameters, and to determine the performance and potential of novel diagnostic methods for pathogen identification, host response profiling and risk stratification as tools to guide clinical management.

In 2018, the eSIMS mobile application was developed in Uganda based on a theory-informed quality improvement platform ^{1 2} to improve vital sign collection and diagnosis of severe illness in a resource-constrained setting. Building on this prior work within the African Research Collaboration on Sepsis (ARCS) and the Ugandan tech company iStreams, STAIRS will develop eSIMS further, aiming to maximize acceptability and overall user experience for health care workers who use the eSIMS app as a quality improvement tool for support of triage, detection and response to severe illness and sepsis on general wards in participating hospitals across the STAIRS network, and determine the effectiveness of e-SIMS in improving the detection of severe illness in patients hospitalized with sepsis.

Early standardized and accurate approaches to identifying, stratifying and managing patients with suspected sepsis are lacking in resource-constrained settings across Sub-Saharan Africa. Alongside limited physical and human resources, a diversity of potential pathogens, increased burden of antimicrobial resistance, inadequate track-and-trigger systems and limited understanding of factors that help risk stratification of patients contribute to the challenges of managing patients who present with suspected sepsis.

Amongst other points, the WHA resolution “Improving the prevention, diagnosis and clinical management of sepsis” calls for the development of innovative means of diagnosing and treating sepsis, including novel diagnostics ¹. Informed by the analysis of archived samples collected as part of the prospective multi-country network cohort of patients hospitalized with sepsis, STAIRS aims to develop and evaluate the impact on processes of care and survival of a comprehensive sepsis diagnostic platform for use at patients’ bedsides.

Sustained morbidity and mortality for both pediatric and adult sepsis patients after hospital discharge has been reported in multiple settings, including Sub-Saharan Africa ^{1 2 3}. Studies aiming to improve discharge procedures and follow-up in Ugandan children after hospitalization with severe infection have resulted in improved medium-term survival and uptake in health seeking behavior ⁴. Leveraging experiences with a Mobile Phone Support Tool for adherence to antiretroviral treatment in young adults in Uganda ⁵, STAIRS will evaluate an mHealth approach in addition to standard of care discharge management for adult patients after sepsis in a randomized controlled trial.