Rethinking Paediatric Sepsis Care through Local Provider Voices and Lived Systems: A Mixed-Methods Study in Two Hospitals in Ghana

  1. Charles Martyn-Dickens
  2. Sheila Agyeiwaa Owusu
  3. Allysa Warling
  4. Michelle Munyikwa
  5. Gustav Nettey
  6. Amundam Mancho
  7. Maraisha Philogene
  8. Evans Otieku
  9. Ernestina Gambrah
  10. John Adabie Appiah
  11. Ahmet Uluer
  12. Rebecca Elaine Cagnina
  13. Emma Otchere
  14. Maame Fremah Kotoh-Mortty
  15. Eugene Martey
  16. Leah Ratner
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Abstract

Background

Paediatric sepsis remains a significant cause of mortality in low- and middle-income countries (LMICs), where health systems are often resource-constrained. Global sepsis protocols, though effective in high-income settings, may not be well-suited to LMIC contexts.

Methods

We conducted a mixed-methods study in two hospitals in the Ashanti Region of Ghana: Komfo Anokye Teaching Hospital (KATH) and Presbyterian Hospital, Agogo (PreHA). Specifically, we conducted a retrospective chart review, followed by key informant interviews with clinical staff, and integrated our findings with a previously published situational analysis. Qualitative data analysis employed the Three Delays Framework and the Donabedian Model to identify locations and causes of delays in care.

Results

Seventy-one charts met the inclusion criteria for review, having a history of fever or hypothermia and complete vital signs documented (16 from PreHA, 55 from KATH). Despite KATH managing more severely ill patients with higher sepsis scores and longer stays, mortality rates were similar at both sites. The chart review highlighted gaps in documentation and inconsistent care processes. Key informant interviews revealed themes such as provider altruism, community financial support, and the positive role of research collaborations, while also illustrating systemic delays linked to financial and resource constraints.

Conclusion

Paediatric sepsis care in Ghana is influenced by complex and interconnected structural, cultural, and procedural factors. Our findings indicate that contextually adapted care pathways are crucial for improving sepsis outcomes in resource-constrained settings. Co-designed interventions, rather than wholly imported protocols, may offer a more sustainable approach to strengthening health systems in LMICs.

What is known on this topic

  • Paediatric sepsis is a major cause of morbidity and mortality globally, especially in LMICs.

  • Standardised sepsis bundles have improved outcomes in high-income countries; however, they pose challenges during implementation in resource-limited settings.

What this study adds

  • Triangulated data show systemic and structural barriers drive delays in care-seeking, access, and treatment.

  • Health system limitations have a more significant impact on clinical outcomes than individual hospital capacity.

  • Locally rooted education, infrastructure, and participatory approaches are needed to improve sepsis care.

How this study may affect research, policy or practice

  • Encourages region-specific adaptations of sepsis guidelines.

  • Highlights the role of research funding and community resilience in supporting resource-limited systems.

  • Reinforces the need for implementation models grounded in the lived experiences of providers and patients.

Article activity feed

  1. Version published to 10.1101/2025.07.15.25331569 on medRxiv