“Everyone needs to know their role”- A needs assessment of sepsis care at a referral hospital in western Kenya

Sepsis and septic shock disproportionately affect individuals in low-and middle-income countries (LMICs), particularly in sub-Saharan Africa. Yet, due to a paucity of data describing sepsis care and outcomes in LMICs, existing international treatment guidelines are not broadly applicable. Little is known about the current state of sepsis clinical management within LMIC settings. We aimed to gain perspectives on current care practices for sepsis from healthcare workers and identify potential gaps for further intervention within a large referral hospital in Kenya. This needs assessment was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, is one of two referral hospitals in the country. Twenty-one semi-structured, individual interviews with general medicine providers at MTRH were conducted in January 2023. Interviewees included medical students, medical officers, clinical officers, nurses, pharmacists, registrars, and consultants. Interviews were performed in English, audio-recorded, and transcribed. Two independent investigators coded and thematically analyzed the data. Five major themes and twelve subthemes emerged from the data. The themes were challenges in laboratory investigations, inconsistent microbiology data, antibiotic use, changes in practice for patients living with HIV, and limited ICU capacity. The emerging themes in our data describe a challenging environment for treating sepsis. Providers face difficulty in choosing effective empiric antibiotic regimens in a setting with high rates of antimicrobial resistance. Inconsistent microbiology data and limited ICU capacity can add to the challenge of providing targeted and supportive care. These themes provide a framework for further intervention to improve outcomes.