Why is India ignorant to sepsis?

3 min read 21 Sep 2019, 02:57 PM IST Neetu Chandra Sharma

WHO passed a resolution urging all United Nations member states to adopt a national action plan for sepsis
Doctors claim that one in six patients diagnosed with sepsis and one in four patients with a severe form of sepsis

A study published in 2016 reported that nearly 30% of the patients admitted into intensive care units in India had sepsis. Photo: iStock

India has yet to come up with effective solutions for sepsis— a life threatening complication of an infection—which may have a high burden in the country. When the rising worldwide burden of sepsis prompted the World Health Organization (WHO) in 2017 to declare sepsis as a global health priority, India has a meagre data on the medical condition. Commonly called ‘blood poisoning’, sepsis is really the adverse consequence of body’s response to an infection, which results in organ damage. The death rate from sepsis exceeds that from heart attacks and cancers in certain parts of the world.

The WHO passed a resolution urging all United Nations member states to adopt a national action plan for sepsis, and recommended inclusion of the prevention, diagnosis and treatment of sepsis in national health system strengthening efforts. A number of countries have developed public health programs -- New York Mandate-USA, UK Sepsis Trust, and Sepsis Kills - Australia -- to raise public awareness and develop guidelines for rapid diagnosis and timely treatment of sepsis.

“It is important to recognise what sepsis is and the magnitude of the problem in India. Many members of the public are not aware of the term 'sepsis' and it is often thought to be synonymous with an infection. Most people get better after an infection, but some patients require hospitalisation due to consequences of an infection, which may arise from sepsis," said Professor Vivekanand Jha Executive Director, The George Institute for Global Health, India

“For example, malaria is recognised by the public as an infection spread by mosquitoes. In mild cases, the common manifestation is fever that responds easily to treatment. In its severe form it can affect the circulation leading to shock, organ damage and unconsciousness, and this condition, where organ dysfunction is present, is 'sepsis'. Sepsis can occur following infection from all classes of microorganisms, including bacteria, viruses, parasites and fungi. As the symptoms can vary from individual to individual, sepsis may often be confused with other conditions in its early stages," he said.

Doctors claim that one in six patients diagnosed with sepsis and one in four patients with a severe form of sepsis, termed septic shock (where the blood pressure goes down to dangerously low levels), will die. Of those who survive, a large proportion will have ongoing physical, psychological or cognitive impairment. Sepsis can damage many organs including the kidneys. The kidney failure may sometimes be irreversible and the patients may require long term dialysis support.

“The precise burden of sepsis in most countries including India is unknown because of the lack of a uniform system of identifying and reporting this condition. Extrapolation of data primarily obtained from high income countries suggests global estimates of 30 million cases, with potentially 5 million deaths annually," Bala Venkatesh, Professor of Intensive Care Medicine, The George Institute for Global Health, Australia.

“Any potential data in India is likely to be hospital-based and hence an underestimate as it will not capture the information on the number of people who do not seek medical advice or do not have access to health care," he said.

A study published in 2016 reported that nearly 30% of the patients admitted into intensive care units in India had sepsis and one in three of these patients died. Studies have also reported a high burden of sepsis in pregnant mothers and the newborn. A 2017 study in the leading journal Lancet reported that communicable diseases (infections) contribute to a substantial proportion of deaths in India. The growing spectre of antimicrobial resistance, (where the bugs have developed mechanisms to counteract the antibiotic) further contributes to the difficulty in management.

“Public surveys have shown low awareness amongst the population about sepsis and its consequences ranging from 14% in Brazil to 40% in Australia. Unfortunately, data on public awareness are not available for India," Dilip Mathai, Dean, Apollo Institute of Medical Sciences & Research (AIMSR), Hyderabad.

“Educating the public and health care providers about sepsis and its symptoms (rapid breathing, altered level of consciousness and poor urine output) encouraging early visit to a health care facility, timely administration of appropriate antibiotics, and rapid treatment according to locally developed guidelines are essential to combat sepsis. This will require concerted and coordinated effort by the governments and the medical fraternity," he said.

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