Interrupting Pathways to Sepsis

UBC Researchers in collaboration with the International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b) have received a $2.9 million CIDA-funded Muskoka Initiative Grant.

Early detection and interruption of pathways to sepsis among women, newborns and young children in least developed countries has been a largely neglected and misunderstood issue. Sepsis is the final common pathway to death for nearly all serious childhood infectious illnesses. Of the nearly 8 million under-five children who die each year, it is estimated that 50 to 70% of these deaths will be the result of children entering this pathway. Approximately 25% of maternal deaths are related to sepsis. The Government of Bangladesh has developed a National Neonatal Health Strategy (NNHS) and Action Plan and adopted Community-Based Case Management of Childhood Illnesses as priority strategies. Both emphasize the need for health service providers to be skilled in identifying, referring and managing sepsis. The strategy specifically calls for the conduct of demonstration projects towards scaling up innovative sepsis responses. In partnership with several Bangladeshi and Canadian organizations, this project will establish demonstration sites in which integrated innovations will be implemented and evaluated that involve the coordinated actions of communities, midwives, TTBAs and primary or secondary care providers in adopting and strengthening mHealth communication and diagnostic innovations, early intervention [detection + referral and transport + treatment] of childhood infections and strengthened health systems.

The ultimate Project objective is to improve maternal and child survival in Bangladesh through the prevention and interruption of pathways to sepsis. Specific objectives include;

1. Strengthened community engagement through community awareness and readiness to participate in sepsis early intervention and prevention activities.
2. Establish demonstration sites that foster the complementary participation of households, communities, primary care and district hospital facilities. Within these sites we will implement and closely monitor intervention packages that provide a combination of the following:
   • Attended deliveries by midwives or TTBAs trained in sepsis identification and early intervention.
   • Integrated Community Case Management (CICM) and Integrated Management of Childhood Illnesses (IMCI) compatible guideline modifications for households and primary care facilities that result in earlier intervention.
   • Modified clinical practice guidelines to be implemented in district or higher level hospitals during and following a syndromic sepsis episode. This will include support for strengthened primary care clinic and hospital management.
   • Cell phone/(mobile) mHealth adaptations to
     • Enhance communication between villages, primary care centres and district hospitals in support of information sharing, decision making, referral and feedback.
     • Obtain vital clinical information to guide treatment or referral decision making, including vital signs and oxygen saturation.
   • Strengthened referral and transport capabilities; working in conjunction with cell phone adaptations
     • Development and refinement of motorized and/or non-motorized ambulance infrastructures. Trailer options for long distance and burdensome terrain conveyance will also be introduced.
     • Ambulance pools staffed by trained paramedics
3. Estimate and describe the burden of early childhood sepsis in Bangladesh and identify modifiable risk factors.
4. Monitor the impact of the project’s intervention packages in terms of disease burden as they are integrated into communities and existing health systems.
5. Document, analyze and disseminate practical lessons and evidence to guide the training and scale-up of interventions to prevent and treat childhood sepsis.
6. Conduct a cost benefit health policy analysis of the intervention packages.

Project Director: Charles P. Larson, MD, Dept. Pediatrics and SPPH
Bangladesh site PI: Shams el Arifeen, MD

Canadian Co-Investigators:
Frances Aboud, PhD, Dept. Psychology (McGill University)
Mark Ansermino, Dept. Anesthesia
Alex Berland, RN, MSc, SPPH
Philippe Schlesser, DesignAid
Paul Dufour, PhD, School of Engineering
Cathy Ellis, Midwife, School of Nursing
Rosemin Kassam, PhD, SPPH
Niranjan Kissoon, MD, Dept. Pediatrics
John Richards, PhD, School of Public health (Simon Fraser University)
Mickey Rostoker, MD, Family Medicine
Chris Ryan, DesignAid

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