Prevalence and mortality rate of sepsis among adults admitted to hospitals in sub-Saharan Africa: a systematic review and meta-analysis.

Due to abundant pathogen diversity and mounting antimicrobial resistance, sepsis is more common in sub-Saharan Africa (sSA). However, there is a lack of consistent reports regarding the prevalence of adult sepsis in the region. Therefore, this study aimed to determine pooled estimates of sepsis prevalence and associated mortality among adults admitted to hospitals in sSA. Medline (through PubMed), Scopus, Embase, and Web of Science were systematically searched for studies of sepsis in sSA published before 13th February 2023. A random-effects meta-analysis of hospital-wide and intensive care unit (ICU)-based sepsis prevalence was performed with a 95% confidence interval (CI). Subgroup analysis was conducted considering geographic region and sepsis diagnostic criteria. Funnel plots and Egger's test were used to assess publication bias. The protocol was submitted to the Prospective Register for Systematic Reviews (PROSPERO) with an identifier (CRD42023396719). Overall, 14 observational studies, published between 2009 and 2022, from eight different sSA countries comprising 31,653 adult patients (5723 with sepsis) were included in the review. Nine studies that were conducted in a hospital-wide setting showed a pooled prevalence and mortality of 17% (95% CI: 12-21%) and 15% (95% CI: 17-35%), respectively. Five studies in the ICUs presented a pooled prevalence and mortality of 31% (95% CI: 24-38%) and 46% (95% CI: 39-54%), respectively. Based on the sub-group analysis, the pooled hospital-wide prevalence of sepsis in East and Southern Africa was 18% (95% CI: 11-25%), and 20% (95% CI: 2-42%), respectively. The pooled prevalence in the ICU was 14% (95% CI: 4-23%) and 13% (95% CI: 5-20%) for East and Southern Africa, respectively. The hospital-wide and ICU-based sepsis prevalence and mortality are high in sSA. Addressing the burden of adult sepsis should be a priority for healthcare systems in sub-Saharan Africa.

Dramatically altered environmental lighting conditions in women with high-risk pregnancy during hospitalization.

The maternal circadian time structure is incredibly important in the entrainment and programing of the fetal and newborn circadian time structure. Natural sunlight is the primary environmental time cue for entrainment of circadian rhythms, but high-risk pregnant women spend most of their time indoors with artificial light sources and extremely low levels of natural light both during the day and night. Because the daily level, timing, duration of light exposure and its spectral properties are important in maintaining the normal circadian physiology in humans, we aimed to evaluate the environmental lighting conditions in high-risk pregnant women admitted to hospital for long-term stay. About 30 patients were included in the study. Exposed illuminance, color temperature and effective circadian radiation dose were measured and recorded every 10 s by light dosimeters attached to the patients' clothing. We documented the illuminance of 29 pregnant women on 235 inpatient days. Median (IQR) measured illuminance was 70 (28-173) lux in the morning, 124 (63-241) lux in the afternoon, 19 (6-53) lux in the evening and 0 (0-0) lux at the night. Median illuminance for the 235 inpatient days of assessment was below the recommended EU standard of 100 lux-60.5% of the mornings and 42.7% of the afternoons. The women confined to indoor locations rarely achieved an illuminances more than 300 lux in the morning and in the afternoon. Compared to women with outdoor mobility, those confined indoors have a significantly lower illuminance and color temperature, both in the morning and in the afternoon. Our study presents the first information about the dramatically altered environmental lighting conditions experienced by high-risk pregnant women during their hospital stay. Their exposure to light while in the hospital is significantly lower than exposure to natural daylight levels and below the recommended EU standard.