Our Areas of Work

High-quality research in Sub-Saharan Africa

The research initiative encompasses five tasks aimed at enhancing the understanding of and response to sepsis in sub-Saharan Africa. STAIRS will:

Description:

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.

References:

[1]Rudd KE, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020 Jan 18;395(10219):200-211. doi: 10.1016/S0140-6736(19)32989-7. PMID: 31954465; PMCID: PMC6970225.

Description:

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.

References:

[1]Rudd KE, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020 Jan 18;395(10219):200-211. doi: 10.1016/S0140-6736(19)32989-7. PMID: 31954465; PMCID: PMC6970225.
[2]Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19. Erratum in: Lancet. 2022 Oct 1;400(10358):1102. PMID: 35065702; PMCID: PMC8841637.
[3]WHA (2017), Improving the prevention, diagnosis and clinical  management of sepsis., URL: https://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R7-en.pdf, access: October 23, 2023
[4]Lewis JM, et al. A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis. Clin Infect Dis. 2022 May 30;74(10):1840-1849. doi: 10.1093/cid/ciab710. PMID: 34407175; PMCID: PMC9155594.
[5]Wiens MO, et al.. Mortality after hospital discharge among children younger than 5 years admitted with suspected sepsis in Uganda: a prospective, multisite, observational cohort study. Lancet Child Adolesc Health. 2023 Aug;7(8):555-566. doi: 10.1016/S2352-4642(23)00052-4. Epub 2023 May 11. PMID: 37182535; PMCID: PMC10543357

Description:

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.

References:

[1]WHO Integrated management of adolescent and adult illness (IMAI) district clinician manual: Hospital care for adolescents and adults., URL: https://www.who.int/publications/i/item/9789241548281, access: November 22, 2023
[2]Cummings MJ, Goldberg E, Mwaka S, Kabajaasi O, Vittinghoff E, Cattamanchi A, Katamba A, Kenya-Mugisha N, Jacob ST, Davis JL. A complex intervention to improve implementation of World Health Organization guidelines for diagnosis of severe illness in low-income settings: a quasi-experimental study from Uganda. Implement Sci. 2017 Nov 6;12(1):126. doi: 10.1186/s13012-017-0654-0. PMID: 29110667; PMCID: PMC5674818.

Description:

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.

References:

[1]WHA (2017), Improving the prevention, diagnosis and clinical  management of sepsis., URL: https://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R7-en.pdf, access: October 23, 2023

Description:

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. 

References:

[1]Wiens MO, et al.. Mortality after hospital discharge among children younger than 5 years admitted with suspected sepsis in Uganda: a prospective, multisite, observational cohort study. Lancet Child Adolesc Health. 2023 Aug;7(8):555-566. doi: 10.1016/S2352-4642(23)00052-4. Epub 2023 May 11. PMID: 37182535; PMCID: PMC10543357.
[2]Lewis JM, et al. A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis. Clin Infect Dis. 2022 May 30;74(10):1840-1849. doi: 10.1093/cid/ciab710. PMID: 34407175; PMCID: PMC9155594.
[3]Jacob ST, et al. Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One. 2009 Nov 11;4(11):e7782. doi: 10.1371/journal.pone.0007782. PMID: 19907656; PMCID: PMC2771355.
[4]British Columbia Children’s Hospital Smart Discharges., URL: https://www.bcchr.ca/smart-discharges, access: October 24, 2023
[5]Twimukye A, et al. Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study. JMIR Mhealth Uhealth. 2021 Jun 14;9(6):e17418. doi: 10.2196/17418. PMID: 34121665; PMCID: PMC8240800.

Strengthening capacity for sepsis research and care

Stairs will:

Description:

The STAIRS network will leverage experiences of Charité University in telemedical intensive care, and collaborate closely with the African Federation of Emergency Medicine (AFEM) to build local capacity for telemedicine and teleconsultancy, aiming to improve early diagnosis and response to severe illness and sepsis in the partner countries. With a focus on sustainability, local ownership, and continuous capacity building, STAIRS will set out to explore feasibility and acceptability of telemedicine and teleconsultancy in pilot hospitals in the two partner countries of Ethiopia and Ghana.

Networking inside and outside the consortium

STAIRS will:

Policy engagement and research transfer

STAIRS will:   

Description:

STAIRS will engage with policymakers in partner countries to communicate results and insights from the network’s research and to help inform political action in line with national, regional and global sepsis strategies for achieving the objectives of the 2017 WHO Sepsis Resolution 1, the 2018 Kampala Declaration of the African Sepsis Alliance 2 and the 2023 Berlin Declaration of the Global Sepsis Alliance 3.

References:

[1]WHA (2017), Improving the prevention, diagnosis and clinical management of sepsis., URL: https://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R7-en.pdf, access: October 23, 2023
[2]African Sepsis Alliance (2018) Kampala Declaration - Commitment to Improvement care for sepsis and severly ill patients in Africa., URL: https://www.africansepsisalliance.org/kampaladeclaration, access: October 24, 2023
[3]Global Sepsis Alliance, Sepsis-Stiftung (2023) Berlin Declaration - An Urgent Call for the Enforcement of the WHA Resolution 70.7 and Reinvigorated Global Action on Sepsis., URL: https://www.worldsepsisday.org/news/2023/9/7/the-berlin-declaration-on-sepsis-an-urgent-call-for-the-enforcement-of-the-wha-resolution-707-and-reinvigorated-global-action-on-sepsis#:~:text=building%20on%20the%20example%20of,funding%20for%20reinvigorated%20global%20action, access: October 30, 2023

Outputs

Presentations, Insights, Material related to Stairs-Sepsis.

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Nov 13, 2023
STAIRS project presentation (SSUNGA meeting in September 2023)
VIDEO
Networking
Research
Presentation
Video
by Shevin Jacob & Torsten Feldt, at SSUNGA78 | 12. Sept 2023
Mar 29, 2023
STAIRS project poster presentation (RHISSA kick-off meeting in March 2023)
PDF, 6.20 MB
Networking
Research
Presentation