Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality

Matthew O Wiens,¹ Elias Kumbakumba,² Niranjan Kissoon,³ J Mark Ansermino,⁴ Andrew Ndamira,² Charles P Larson<sup>5

1</sup>School of Population and Public Health, University of British Columbia, Vancouver, Canada; ²Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda; ³Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada; ⁴Department of Anesthesia, BC Children's Hospital and University of British Columbia, Vancouver, Canada; ⁵Department of Pediatrics and School of Population and Public Health, University of British Columbia, Vancouver, Canada

Abstract: Sepsis represents the progressive underlying inflammatory pathway secondary to any infectious illness, and ultimately is responsible for most infectious disease-related deaths. Addressing issues related to sepsis has been recognized as an important step towards reducing morbidity and mortality in developing countries, where the majority of the 7.5 million annual deaths in children under 5 years of age are considered to be secondary to sepsis. However, despite its prevalence, sepsis is largely neglected. Application of sepsis definitions created for use in resource-rich countries are neither practical nor feasible in most developing country settings, and alternative definitions designed for use in these settings need to be established. It has also been recognized that the inflammatory state created by sepsis increases the risk of post-discharge morbidity and mortality in developed countries, but exploration of this issue in developing countries is lacking. Research is urgently required to characterize better this potentially important issue.

Keywords: children, pediatric sepsis, developing countries