Academic journal article Bulletin of the World Health Organization

Nationwide Survey on Resource Availability for Implementing Current Sepsis Guidelines in Mongolia/Enquete Nationale Sur la Disponibilite Des Ressources Pour L'application Des Recommandations Sur la Septicemie En Mongolie/Encuesta Nacional Sobre Disponibilidad De Recursos Para Aplicar Las Directrices Actuales Para El Manejo De Casos De Septicemia En Mongolia

Academic journal article Bulletin of the World Health Organization

Nationwide Survey on Resource Availability for Implementing Current Sepsis Guidelines in Mongolia/Enquete Nationale Sur la Disponibilite Des Ressources Pour L'application Des Recommandations Sur la Septicemie En Mongolie/Encuesta Nacional Sobre Disponibilidad De Recursos Para Aplicar Las Directrices Actuales Para El Manejo De Casos De Septicemia En Mongolia

Article excerpt

Introduction

Sepsis is the leading cause of death in intensive care units (ICUs) in high-income countries, and its incidence is on the rise. (1) Annually, 750 000 cases of sepsis occur in the United States of America (USA). (2) In Germany, sepsis claims 60 000 lives a year and is the third most common cause of death. (3) Despite these disquieting figures from high-income countries, most of the global burden of sepsis occurs in middle- and low-income countries, where approximately two-thirds of the world's population resides. (4) Low living standards and poor hygienic conditions, together with widespread malnutrition and bacterial, parasitic and HIV infections, further increase the burden of sepsis in these countries. (5) According to the latest global burden of disease report of the World Health Organization (WHO), three infectious diseases were among the four most frequent causes of death in low-income countries. (6)

Mongolia is home to about 2.6 million people and is classified as a middle-income country by The World Bank. (4) Despite an economic boom following the end of communist rule in 1990, Mongolia faces substantial political, social and health-care problems. Insurance systems are insufficient, and Mongolia's health policy still favours spending on curative rather than preventive services, although there is a renewed focus on primary health care. In 2005, the average life expectancy at birth in Mongolia was 65 years. (7) Three infectious diseases are among the top 10 causes of death in the country, (7) where sepsis is the single most frequent diagnosis in patients admitted to ICUs. (8) In a 2008 study, the rate of sepsis among patients admitted to ICUs was found to be twice as high in Mongolia as in Austria. (9)

In 2001, 2004 and 2008, international experts released guidelines for the management of patients with severe sepsis and septic shock. (10-12) Known as the Surviving Sepsis Campaign (SSC) guidelines, they are among the first international consensus guidelines for septic patients needing intensive care and include recommendations on initial resuscitation, infection management, haemodynamic support, adjunctive therapy and other supportive measures. (12) Integration of the SSC guidelines into clinical care significantly improves clinical outcomes. (13-15) Because sepsis is the leading cause of death in the ICUs of high-income countries, (1) the SSC guidelines are considered a milestone in improving the care and clinical outcomes of the critically ill. However, certain resources are required to implement SSC guidelines. These resources, which are routinely available in high-income countries, are often lacking in health-care facilities in middle- or low-income countries, according to recent reports. (16-20) The availability of the resources needed to properly treat sepsis in middle- or low-income countries needs to be investigated so that the SSC guidelines can be adapted and implemented in the light of what is available.

The objective of this nationwide survey was to investigate the availability of the resources needed to implement the most recent SSC guidelines in secondary and tertiary hospitals in Mongolia. We hypothesized that such resources were not available in Mongolian hospitals, particularly in rural areas.

Methods

In October 2009 we conducted a nationwide survey in Mongolia by mailing 44 questionnaires to all 24 secondary and tertiary hospitals in Ulaanbaatar, the capital city, henceforth known as central hospitals, and all 20 provincial referral hospitals in rural areas, henceforth known as peripheral hospitals. There is one provincial referral hospital in each of the 20 provinces (aimags) of Mongolia (excluding Ulaanbaatar), which are further subdivided into soums, where hospitals mostly provide primary health care. Each questionnaire was directed to the head physician of the ICU or, if the hospital had no ICU, to the department caring for emergency and critically ill patients. …

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