Time-critical sepsis interventions and clinical outcomes among children in a tertiary Tanzanian emergency department

Abstract

Abstract Background Pediatric sepsis remains a leading cause of mortality in resource-limited settings. We evaluated the delivery of time-critical sepsis interventions and their association with in-hospital mortality among children in Tanzania. Methods We conducted a secondary analysis of a prospective cohort of children (28 days to 14 years) presenting with sepsis to the Emergency Medicine Department at Muhimbili National Hospital, Dar es Salaam, Tanzania (July 2022 to November 2024). Sepsis was defined as fever and at least one World Health Organization warning sign. Local pediatric sepsis guidelines recommend antibiotics and intravenous fluids (IVF) for all patients with sepsis, regardless of the source. Primary exposures were receipt and timing of antibiotics and IVF. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, nutritional status, referral status, and illness severity. Results Among 755 children, 61.2% ( n = 462) received antibiotics, and 55.6% ( n = 420) received IVF. Median time to intervention was 2.4 h (IQR 1.6–3.7). 35.5% ( n = 268) received both interventions, and only 3.7% ( n = 28) received them within one hour. In-hospital mortality was 19.6% ( n = 148), with a median time to death of 4.1 days (IQR 1.6–9.5). In a multivariable analysis, time to initiation of both antibiotics and IVF was not significantly associated with in-hospital mortality (adjusted OR 1.29; 95% CI 0.83–2.0; p = 0.264). When modeled continuously, a longer time to IVF administration was associated with increased mortality risk (HR 1.05 per hour delay; 95% CI 1.01–1.10). Conclusions Receipt of time-critical sepsis interventions (antibiotics and IVF) was delayed and inconsistent, with no observed association with decreased mortality, although residual confounding may remain. This both highlights gaps in early evidence-based care delivery and suggests additional, system-related influences on pediatric sepsis outcomes. Our findings underscore the need for context-specific strategies to strengthen pediatric sepsis management in resource-limited settings.