Richard Stead, CEO of Qures, proposes a new approach to sepsis care in Africa designed to give clinicians more time to identify the cause of infection and deliver the treatment most likely to work.
Sepsis can move faster than medicine.
A critically ill patient can deteriorate from infection to shock, organ dysfunction and death while clinicians are still trying to establish what is wrong, identify the cause and determine which treatment is most likely to work.
This presents a particular challenge for sepsis in Africa, where healthcare facilities can face limited laboratory capacity, shortages of critical-care beds, restricted access to oxygen and difficulties transferring patients to specialist centres.
The response to sepsis has traditionally focused on recognising infection quickly and starting empirical antimicrobial treatment. That remains essential. But as antimicrobial resistance increases, the first treatment selected may not always be effective, while laboratory testing can take time to establish the organism responsible and its antimicrobial susceptibility.
This creates a critical gap.
A proposed new funding priority, known as The First 24 Hours of Sepsis, argues that more attention should be given to keeping critically ill patients alive and physiologically stable while clinicians establish the cause of their illness and determine the most effective treatment.
The central proposition is simple: Give clinicians time.
Sepsis in Africa is a race against time
The World Health Organization (WHO) African Region carries a disproportionate burden of maternal, newborn and child mortality. Approximately 178,000 mothers and one million newborns die each year, many from preventable causes, while the region accounts for around 70% of global maternal deaths.
Sepsis is an important contributor to this burden.
The traditional response to sepsis relies heavily on early recognition followed by empirical antimicrobial treatment. This approach has saved countless lives and must remain part of emergency care.
However, clinicians frequently do not yet know the organism or its resistance profile when a critically ill patient first arrives.
The consequences of this gap can be significant. A recent survey involving neonatal clinicians from 40 of 48 sub-Saharan African countries found that 50.3% reported difficulty accessing antibiotics. Some 14.9% said blood-culture results never arrived in time to influence care, while a further 28.6% received useful results in time less than half the time.
Evidence from Ethiopia highlights the challenge further. In one neonatal cohort, 44.9% of organisms causing healthcare-associated sepsis were resistant to first-line empirical treatment.
The problem, therefore, cannot be solved simply by demanding an earlier diagnosis than is currently possible.
Instead, it raises a different question: Can we keep the patient alive long enough to obtain a better answer?
Why the first 24 hours matter
The First 24 Hours concept proposes making this survival window a distinct international research and investment priority.
The objective is not to delay antibiotics, source control, resuscitation or existing evidence-based treatment. Instead, it is to develop additional interventions that reduce the risk of patients dying from physiological collapse while definitive treatment is being established.
Research could focus on therapies and technologies capable of maintaining circulation and tissue perfusion, protecting threatened organs, supporting respiratory function and preventing progression to refractory shock.
Other potential areas include modulating harmful host responses without compromising infection control, protecting kidney, brain, heart and endothelial function, improving metabolic stability and providing simplified physiological support for hospitals without advanced intensive-care facilities.
This would require research into host-directed therapies, organ-protective treatments, immunomodulation, endothelial protection, metabolic interventions and simplified life-support technologies.
Not all of these approaches will prove effective. That is precisely why rigorous African-led research and clinical trials are required.
The investment proposition is therefore different from conventional sepsis research: Do not rely solely on finding the pathogen faster. Invest in extending the patient’s survival window while medicine determines the right treatment.
A different approach to sepsis in Africa
For sepsis in Africa, a strategy based entirely on increasingly sophisticated rapid diagnostics risks favouring the best-resourced hospitals.
Many healthcare facilities face more fundamental constraints, including limited laboratory capacity, unreliable supplies, shortages of critical-care beds, restricted access to oxygen and difficulties transferring patients to specialist centres.
Even an excellent diagnostic test cannot solve every problem if the effective medicine is unavailable or a patient deteriorates before treatment can take effect.
The First 24 Hours strategy therefore asks whether physiological support can be made simpler, affordable, robust and deployable closer to the patient.
The goal is not to reproduce a European or North American intensive-care unit in every district hospital. Instead, it is to identify the minimum package of interventions necessary to prevent reversible sepsis from becoming irreversible organ failure.
Such an approach could have implications for district hospitals, maternity services and neonatal units.
Empowering frontline teams to act quickly
A new treatment strategy also requires a different model of clinical decision-making.
Sepsis does not respect organisational hierarchy. A deteriorating patient cannot safely wait while information passes sequentially from nurse to junior clinician, senior clinician, specialist and referral centre before essential stabilising actions take place.
The solution is not to remove clinical accountability or specialist expertise. Rather, it is to distinguish between decisions that require specialist judgement and time-critical stabilisation that appropriately trained frontline professionals can safely initiate through agreed protocols.
Nurses, midwives, clinical officers, doctors, pharmacists and laboratory teams should operate as multidisciplinary emergency teams with clearly defined responsibilities.
The principle is straightforward: Confidence and authority to stabilise at the bedside. Expertise available immediately to support it.
WHO’s Basic Emergency Care approach already supports strengthening the capabilities of first-contact healthcare workers, including nurses, doctors, clinical officers and ambulance providers, to manage time-critical emergencies.
The proposal argues that funders should build on this principle by increasing confidence among frontline critical-care teams.
Maternal and newborn sepsis should be a priority
Mothers and newborn babies should be a priority population for First 24 Hours research.
There is already evidence that strengthening basic systems and empowering frontline teams can improve outcomes.
The Active Prevention and Treatment of Maternal Sepsis programme operated across 59 hospitals in Malawi and Uganda and involved more than 431,000 women giving birth.
Using improved infection prevention and the FAST-M approach, which stands for Fluids, Antibiotics, Source control, Transfer and Monitoring, participating hospitals achieved a 32% reduction in infection-related maternal mortality and severe morbidity.
The lesson extends beyond maternity care.
Reliable basic interventions, delivered rapidly by empowered teams, can change outcomes.
The proposed next step is to combine these systems with research specifically designed to establish how physiological stability can be maintained during the critical period before definitive treatment is known to be effective.
Building an African-led sepsis research programme
The proposed Africa First 24 Hours Sepsis Programme would be organised around five priorities:
Survival therapeutics
Research would focus on treatments that prevent or slow organ failure during early sepsis, including host-directed, organ-protective and adjunctive therapies.
The target outcome would be straightforward: More patients alive and physiologically stable at 24 hours.
Affordable physiological support
Simplified technologies for circulation, oxygenation, monitoring and organ support would be developed for use in district hospitals and maternity and neonatal units.
Crucially, innovation would need to be designed around African operating environments from the beginning.
Targeted treatment during the survival window
Diagnostics would remain important, but their role would sit within a broader pathway.
The additional survival time would allow clinicians to establish:
- What is causing the illness?
- Where is the source?
- Which antimicrobial is likely to work?
- Does the patient require surgery or drainage?
- What treatment should follow?
Diagnosis therefore becomes part of the pathway rather than the principal innovation target.
Frontline authority
Protocols, training and regulatory frameworks would enable appropriately trained professionals to initiate predefined stabilising interventions without avoidable hierarchical delay.
African-led trials
African researchers and institutions should lead the evaluation of these approaches.
Trials would need to include district hospitals and maternity and neonatal services, rather than focusing only on major academic centres.
Treatments intended for Africa must be proven with African patients, organisms, health systems and clinical teams.
Measuring what matters in sepsis care
A change in research priorities would also require funders to reconsider how success is measured.
Funding programmes frequently measure activity, such as staff trained, equipment purchased, workshops delivered or guidelines distributed.
The First 24 Hours programme should instead focus on outcomes.
Potential measures include:
- Survival at 6, 12 and 24 hours
- Progression, or non-progression, to organ failure
- Time from deterioration to stabilising treatment
- The proportion receiving effective targeted antimicrobial treatment once susceptibility is known
- Time to source control
- Maternal and neonatal survival
- Overall survival and disability after sepsis
The key question for funders should therefore move beyond whether a hospital followed a protocol.
It should be: Did the patient survive long enough for medicine to find and treat the cause?
Filling the gap between diagnosis and treatment
The First 24 Hours programme would not compete with antimicrobial development, infection prevention, vaccination or improved diagnostics. All remain essential.
Instead, it would seek to fill a neglected gap between them.
The current pathway is often:
Suspected infection → empirical treatment → wait for information → deterioration or recovery
The proposed approach is:
Suspected sepsis → immediate stabilisation → protect organs and maintain survival → identify cause and resistance → targeted treatment and source control → recovery
This shift could become particularly important as antimicrobial resistance increases.
A future in which clinicians repeatedly change antibiotics while a patient’s organs continue to fail is not an adequate sepsis strategy.
We need treatments for the patient as well as treatments against the pathogen.
A call to fund the first 24 hours
Africa has an opportunity to establish a fundamentally different approach to sepsis.
The proposal calls for a major collaborative programme bringing together African universities and hospitals, governments, international research organisations, biotechnology and pharmaceutical companies, engineers, clinicians, nurses, midwives and patient organisations.
Its mission should be explicit: Keep the patient alive for the first 24 hours
During those hours, clinicians would continue existing emergency treatment while establishing the infection, antimicrobial susceptibility, source and most appropriate definitive therapy.
This is not an argument for delaying diagnosis.
It is an argument for recognising a clinical reality: Diagnosis requires time. Sepsis may not give us that time.
The task is therefore to create it.
For funders, that means prioritising treatments that protect the patient while the cause is established, affordable technologies that support failing physiology, African-led trials of host-directed and organ-protective therapies, empowered frontline teams, rapid access to specialist expertise without hierarchical delay, and definitive antimicrobial and source-directed treatment as soon as the evidence becomes available.
The objective is ambitious but measurable – to give a mother, newborn, child or adult with severe sepsis the best possible chance of remaining alive and treatable through the first 24 hours, long enough to identify the cause and deliver the treatment most likely to work.
For sepsis in Africa, the proposal is ultimately about buying something medicine urgently needs: Time.
Buy time. Protect organs. Find the cause. Target the treatment. Save the patient.
