Prevalence, associated factors and outcomes of septic shock among children with suspected infection in rural Uganda: a cross-sequential study

In Uganda, septic shock is a significant concern and one of the major contributors to mortality, more especially among the children. It is important to understand the factors associated with septic shock in our setting as well as the outcomes in order to improve the outcomes. This study determined the prevalence, factors associated and outcomes of septic shock among children admitted with suspected infection at Fortportal Regional Referral Hospital (FPRRH) in Uganda. A cross-sequential study design was used in this study. All children aged 1 month to 12 years presenting with features of suspected infection at FPRRH were included following consent. A diagnosis of septic shock was made in the presence of suspected infection and a Phoenix Sepsis Score of > 2 points, plus a cardiovascular sub score of at least 1 point. The children were then followed up until they were discharged from the hospital. Binary logistic regression analysis was done to determine the significant factors. The prevalence of septic shock was 41.5% (175/422). The independent factors associated with septic shock were: Being referred (aOR = 2.895, CI = 1.690–4.957, P < 0.001), having malaria (aOR = 2.072, CI = 1.127–3.809, P = 0.019), having severe acute malnutrition (aOR = 2.638, CI = 1.203–5.786, P = 0.016), neutrophilia (aOR = 2.244, CI = 1.125–4.479, P = 0.022) and anemia (aOR = 2.346, CI = 1.274–4.318, P = 0.006) for moderate as well as (aOR = 3.339, CI = 1.520–7.335, P = 0.003) for severe anemia. The mortality rates were significantly higher among those with septic shock compared to those with no sepsis (9.1% versus 0.0%, P < 0.001). The proportion of participants that had prolonged hospital stay was significantly higher among those with septic shock compared to those with no sepsis (17.6% versus 7.5%, P = 0.006). The prevalence of septic shock was high, with associated higher rates for mortality and prolonged hospital stay. Paying close attention to the identified modifiable factors through screening, education and management of malnutrition, anemia and malaria may play a role in reducing the burden.