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other·critical care, infectious disease, public health, internal medicine, epidemiology·PMC10021962

Facilitating high quality acute care in resource-constrained environments: Perspectives of patients recovering from sepsis, their caregivers and healthcare workers in Uganda and Malawi

PLOS Global Public Health · 12 authors, 6 centres

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TL;DR

This qualitative study explored perspectives on sepsis care quality among patients, caregivers, and healthcare workers in Uganda and Malawi.

Full summary

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A qualitative descriptive study was conducted in public hospitals in Uganda and Malawi. Methods included semi-structured interviews with patients recovering from sepsis, their caregivers, and healthcare workers. Central results indicated that sepsis care occurred in severely resource-constrained environments, which compromised the capacity to deliver safe, consistent, and accessible care. These factors contributed to delays in care, compromised clinical assessments, and suboptimal treatment. Implications suggest that improving hospital-level resources and interpersonal engagement could help facilitate higher quality sepsis care in similar resource-constrained settings.

STUDY TYPE

other

SPECIALTY

critical care

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10021962

Facilitating high quality acute care in resource-constrained environments: Perspectives of patients recovering from sepsis, their caregivers and healthcare workers in Uganda and Malawi

PLOS Global Public Health

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ABSTRACT

Sepsis is a major global health problem, especially in sub-Saharan Africa. Improving patient care requires that healthcare providers understand patients’ priorities and provide quality care within the confines of the context they work. We report the perspectives of patients, caregivers and healthcare workers regarding care quality for patients admitted for sepsis to public hospitals in Uganda and Malawi. This qualitative descriptive study in two hospitals included face-to face semi-structured interviews with purposively selected patients recovering from sepsis, their caregivers and healthcare workers. In both Malawi and Uganda, sepsis care often occurred in resource-constrained environments which undermined healthcare workers’ capacity to deliver safe, consistent and accessible care. Constraints included limited space, strained; water, sanitation and hygiene (WASH) amenities and practices, inadequate human and material resources and inadequate provision for basic needs including nutrition. Heavy workloads for healthcare workers strained relationships, led to poor communication and reduced engagement with patients and caregivers. These consequences were exacerbated by understaffing which affected handover and continuity of care. All groups (healthcare workers, patients and caregivers) reported delays in care due to long queues and lack of compliance with procedures for triage, treatment, stabilization and monitoring due to a lack of expertise, supervision and context-specific sepsis management guidelines. Quality sepsis care relies on effective severity-based triaging, rapid treatment of emergencies and individualised testing to confirm diagnosis and monitoring. Hospitals in resource-constrained systems contend with limitations in key resources, including for space, staff, expertise, equipment and medicines, in turn contributing to gaps in areas such as WASH and effective care delivery, as well as communication and other relational aspects of care. These limitations are the predominant challenges to achieving high quality care.

CITATION EXPORT

Felix Limbani, Olive Kabajaasi, Margaret Basemera et al.. Facilitating high quality acute care in resource-constrained environments: Perspectives of patients recovering from sepsis, their caregivers and healthcare workers in Uganda and Malawi. PLOS Global Public Health. (2022). https://doi.org/10.1371/journal.pgph.0000272

AUTHORS

12 · 6 CENTRES

Felix Limbani, Olive Kabajaasi, Margaret Basemera, Kate Gooding, Nathan Kenya-Mugisha, Mercy Mkandawire, Davis Rusoke, Shevin T. Jacob, Anne Ruhweza Katahoire, Jamie Rylance, M. Dylan Bould, M. Dylan Bould

1 Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
2 Walimu, Kampala, Uganda
3 Oxford Policy Management, Oxford, United Kingdom
4 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
5 Child Health and Development Center, Makerere University, Kampala, Uganda
Children’s Hospital of Eastern Ontario, University of Ottawa, CANADA

EDITOR / REVIEWER

M. Dylan Bould