{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:38:19Z","timestamp":1792633099058,"version":"4.5.0"},"reference-count":61,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":90,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32HD049303"],"award-info":[{"award-number":["5T32HD049303"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI144029"],"award-info":[{"award-number":["K23AI144029"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of a prospective cohort of children (28\u00a0days to 14\u00a0years) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 755 children, 61.2% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009462) received antibiotics, and 55.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009420) received IVF. Median time to intervention was 2.4\u00a0h (IQR 1.6\u20133.7). 35.5% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009268) received both interventions, and only 3.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928) received them within one hour. In-hospital mortality was 19.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009148), with a median time to death of 4.1\u00a0days (IQR 1.6\u20139.5). 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\u20132.0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.264). 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\u20131.10).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-026-07369-2","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:26:27Z","timestamp":1784863587000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time-critical sepsis interventions and clinical outcomes among children in a tertiary Tanzanian emergency department"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8444-4968","authenticated-orcid":false,"given":"Abigail M.","family":"Sorensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raya Y.","family":"Mussa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erasto M.","family":"Sunzula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria M.","family":"Mlele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6560-3334","authenticated-orcid":false,"given":"Scott P.","family":"Oltman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia L.","family":"Msemwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lushona K.","family":"Mathias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen S.","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jazmin M.","family":"Baez-Maidana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juma A.","family":"Mfinanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7480-965X","authenticated-orcid":false,"given":"Victoria T.","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9684-419X","authenticated-orcid":false,"given":"Anneka M.","family":"Hooft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namala P.","family":"Mkopi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1388-3901","authenticated-orcid":false,"given":"Joel P.","family":"Manyahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3326-1736","authenticated-orcid":false,"given":"Teresa B.","family":"Kortz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0395-5385","authenticated-orcid":false,"given":"Hendry R.","family":"Sawe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"issue":"8","key":"7369_CR1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","volume":"315","author":"M Singer","year":"2016","unstructured":"Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801\u201310. https:\/\/doi.org\/10.1001\/jama.2016.0287.","journal-title":"JAMA"},{"issue":"2","key":"7369_CR2","doi-asserted-by":"publisher","first-page":"e212","DOI":"10.1016\/S2214-109X(24)00450-9","volume":"13","author":"TB Kortz","year":"2025","unstructured":"Kortz TB, Holloway A, Agulnik A, et al. Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study. Lancet Glob Health. 2025;13(2):e212\u201321. https:\/\/doi.org\/10.1016\/S2214-109X(24)00450-9.","journal-title":"Lancet Glob Health"},{"issue":"11","key":"7369_CR3","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","volume":"49","author":"L Evans","year":"2021","unstructured":"Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063\u2013143. https:\/\/doi.org\/10.1097\/CCM.0000000000005337.","journal-title":"Crit Care Med"},{"issue":"6","key":"7369_CR4","doi-asserted-by":"publisher","first-page":"e1585","DOI":"10.1542\/peds.2010-3513","volume":"127","author":"GY Larsen","year":"2011","unstructured":"Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011;127(6):e1585\u201392. https:\/\/doi.org\/10.1542\/peds.2010-3513.","journal-title":"Pediatrics"},{"issue":"9","key":"7369_CR5","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1097\/PCC.0000000000000858","volume":"17","author":"F Balamuth","year":"2016","unstructured":"Balamuth F, Weiss SL, Fitzgerald JC, et al. Protocolized treatment is associated with decreased organ dysfunction in pediatric severe sepsis*. Pediatr Crit Care Med. 2016;17(9):817. https:\/\/doi.org\/10.1097\/PCC.0000000000000858.","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"7369_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2157-z","volume":"22","author":"KE Rudd","year":"2018","unstructured":"Rudd KE, Kissoon N, Limmathurotsakul D, et al. The global burden of sepsis: barriers and potential solutions. Crit Care. 2018;22(1):232. https:\/\/doi.org\/10.1186\/s13054-018-2157-z.","journal-title":"Crit Care"},{"issue":"12","key":"7369_CR7","doi-asserted-by":"publisher","first-page":"e2013","DOI":"10.1016\/S2214-109X(25)00356-0","volume":"13","author":"AP Gray","year":"2025","unstructured":"Gray AP, Chung E, Hsu RL, et al. Global, regional, and national sepsis incidence and mortality, 1990\u20132021: a systematic analysis. Lancet Glob Health. 2025;13(12):e2013\u201326. https:\/\/doi.org\/10.1016\/S2214-109X(25)00356-0.","journal-title":"Lancet Glob Health"},{"issue":"6","key":"7369_CR8","doi-asserted-by":"publisher","first-page":"e190337","DOI":"10.1001\/jamapediatrics.2019.0337","volume":"173","author":"RC Reiner","year":"2017","unstructured":"GBD 2017 Child and Adolescent Health Collaborators, Reiner RC, Olsen HE, et al. Diseases, injuries, and risk factors in child and adolescent health, 1990 to 2017: findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study. JAMA Pediatr. 2017;173(6):e190337. https:\/\/doi.org\/10.1001\/jamapediatrics.2019.0337.","journal-title":"JAMA Pediatr"},{"key":"7369_CR9","doi-asserted-by":"publisher","unstructured":"Hidalgo JL, Kumar VK, Akech SO, et al. The Sepsis Chain of Survival: A Comprehensive Framework for Improving Sepsis Outcomes. Crit Care Med. https:\/\/doi.org\/10.1097\/CCM.0000000000006796.","DOI":"10.1097\/CCM.0000000000006796"},{"issue":"4","key":"7369_CR10","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1001\/jama.2018.9071","volume":"320","author":"IVR Evans","year":"2018","unstructured":"Evans IVR, Phillips GS, Alpern ER, et al. Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis. JAMA. 2018;320(4):358. https:\/\/doi.org\/10.1001\/jama.2018.9071.","journal-title":"JAMA"},{"issue":"11","key":"7369_CR11","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1097\/CCM.0000000000000509","volume":"42","author":"SL Weiss","year":"2014","unstructured":"Weiss SL, Fitzgerald JC, Balamuth F, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis*. Crit Care Med. 2014;42(11):2409. https:\/\/doi.org\/10.1097\/CCM.0000000000000509.","journal-title":"Crit Care Med"},{"issue":"9","key":"7369_CR12","doi-asserted-by":"publisher","first-page":"3640","DOI":"10.1128\/AAC.49.9.3640-3645.2005","volume":"49","author":"M Morrell","year":"2005","unstructured":"Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49(9):3640\u20135. https:\/\/doi.org\/10.1128\/AAC.49.9.3640-3645.2005.","journal-title":"Antimicrob Agents Chemother"},{"issue":"10","key":"7369_CR13","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1111\/j.1399-6576.2007.01439.x","volume":"51","author":"M Varpula","year":"2007","unstructured":"Varpula M, Karlsson S, Parviainen I, Ruokonen E, Pettil\u00e4 V. Community-acquired septic shock: early management and outcome in a nationwide study in Finland. Acta Anaesthesiol Scand. 2007;51(10):1320\u20136. https:\/\/doi.org\/10.1111\/j.1399-6576.2007.01439.x.","journal-title":"Acta Anaesthesiol Scand"},{"issue":"6","key":"7369_CR14","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.13955","volume":"7","author":"RD Lane","year":"2024","unstructured":"Lane RD, Richardson T, Scott HF, et al. Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis. JAMA Netw Open. 2024;7(6):e2413955. https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.13955.","journal-title":"JAMA Netw Open"},{"issue":"26","key":"7369_CR15","doi-asserted-by":"publisher","first-page":"2483","DOI":"10.1056\/NEJMoa1101549","volume":"364","author":"K Maitland","year":"2011","unstructured":"Maitland K, Kiguli S, Opoka RO, et al. Mortality after Fluid Bolus in African Children with Severe Infection. N Engl J Med. 2011;364(26):2483\u201395. https:\/\/doi.org\/10.1056\/NEJMoa1101549.","journal-title":"N Engl J Med"},{"key":"7369_CR16","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.755484","volume":"9","author":"DNM Medeiros","year":"2021","unstructured":"Medeiros DNM, Shibata AO, Pizarro CF, de LA Rosa M, Cardoso MP, Troster EJ. Barriers and Proposed Solutions to a Successful Implementation of Pediatric Sepsis Protocols. Front Pediatr. 2021;9:755484. https:\/\/doi.org\/10.3389\/fped.2021.755484.","journal-title":"Front Pediatr"},{"key":"7369_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2022.103255","volume":"72","author":"M Taj","year":"2022","unstructured":"Taj M, Brenner M, Sulaiman Z, Pandian V. Sepsis protocols to reduce mortality in resource-restricted settings: a systematic review. Intensive Crit Care Nurs. 2022;72:103255. https:\/\/doi.org\/10.1016\/j.iccn.2022.103255.","journal-title":"Intensive Crit Care Nurs"},{"issue":"2","key":"7369_CR18","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002471","volume":"38","author":"A Mesiwala","year":"2022","unstructured":"Mesiwala A, Suleman S, Sundararajan R, et al. Recognition and Management of Pediatric Sepsis in a Resource-Limited Emergency Department in Mwanza, Tanzania: A Qualitative Study. Pediatr Emerg Care. 2022;38(2):e900. https:\/\/doi.org\/10.1097\/PEC.0000000000002471.","journal-title":"Pediatr Emerg Care"},{"issue":"4 Suppl","key":"7369_CR19","doi-asserted-by":"publisher","first-page":"e156S","DOI":"10.1378\/chest.14-0744","volume":"146","author":"J Geiling","year":"2014","unstructured":"Geiling J, Burkle FM, Amundson D, et al. Resource-poor settings: infrastructure and capacity building: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4 Suppl):e156S \u2013 e167. https:\/\/doi.org\/10.1378\/chest.14-0744.","journal-title":"Chest"},{"issue":"1","key":"7369_CR20","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-022-03503-y","volume":"22","author":"AN Simbila","year":"2022","unstructured":"Simbila AN, Kilindimo SS, Sawe HR, et al. Predictors and outcome of time to presentation among critically ill paediatric patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Pediatr. 2022;22(1):1. https:\/\/doi.org\/10.1186\/s12887-022-03503-y.","journal-title":"BMC Pediatr"},{"key":"7369_CR21","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2017.00278","volume":"5","author":"TB Kortz","year":"2017","unstructured":"Kortz TB, Sawe HR, Murray B, Enanoria W, Matthay MA, Reynolds T. Clinical presentation and outcomes among children with sepsis presenting to a public tertiary hospital in Tanzania. Front Pediatr. 2017;5:278. https:\/\/doi.org\/10.3389\/fped.2017.00278.","journal-title":"Front Pediatr"},{"key":"7369_CR22","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.805518","volume":"9","author":"SA Lau-Braunhut","year":"2022","unstructured":"Lau-Braunhut SA, Smith AM, Steurer MA, et al. Functional Outcomes and Morbidity in Pediatric Sepsis Survivors: A Tanzanian Experience. Front Pediatr. 2022;9:805518. https:\/\/doi.org\/10.3389\/fped.2021.805518.","journal-title":"Front Pediatr"},{"key":"7369_CR23","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.764163","author":"AM Smith","year":"2021","unstructured":"Smith AM, Sawe HR, Matthay MA, Murray BL, Reynolds T, Kortz TB. Delayed presentation and mortality in children with sepsis in a public tertiary care hospital in Tanzania. Front Pediatr. 2021. https:\/\/doi.org\/10.3389\/fped.2021.764163.","journal-title":"Front Pediatr"},{"issue":"1","key":"7369_CR24","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-024-04620-6","volume":"24","author":"RE Lyimo","year":"2024","unstructured":"Lyimo RE, Said YH, Kivuyo SL, Nkya D, Furia FF. Mortality and associated factors among children admitted to an intensive care unit in Muhimbili national hospital, from the time of admission to three months after discharge: a prospective cohort study. BMC Pediatr. 2024;24(1):170. https:\/\/doi.org\/10.1186\/s12887-024-04620-6.","journal-title":"BMC Pediatr"},{"key":"7369_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-023-00858-y","author":"EA Mboya","year":"2019","unstructured":"Mboya EA, Ndumwa HP, Amani DE, et al. Critical illness at the emergency department of a Tanzanian national hospital in a three-year period 2019\u20132021. BMC Emerg Med. 2019. https:\/\/doi.org\/10.1186\/s12873-023-00858-y.","journal-title":"BMC Emerg Med"},{"key":"7369_CR26","volume-title":"Standard treatment guidelines and national essential medicines list for Tanzania Mainland","author":"The United Republic of Tanzania","year":"2021","unstructured":"The United Republic of Tanzania. Standard treatment guidelines and national essential medicines list for Tanzania Mainland. 6th ed. Ministry of Health, Community Development, Gender, Elderly, and Children; 2021.","edition":"6th ed"},{"key":"7369_CR27","doi-asserted-by":"publisher","unstructured":"Hidalgo JL, Akech SO, Acharya SP, et al. The Frame of Survival for Sepsis: A Practical Systems Framework for Time-Sensitive Critical Illness in Low-Resource Settings. Crit Care Med. https:\/\/doi.org\/10.1097\/CCM.0000000000007093.","DOI":"10.1097\/CCM.0000000000007093"},{"key":"7369_CR28","unstructured":"WHO. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources. Geneva: World Health Organization; 2013."},{"key":"7369_CR29","doi-asserted-by":"publisher","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2). https:\/\/doi.org\/10.1016\/j.jbi.2008.08.010","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"7369_CR30","volume-title":"Handbook IMCI: integrated management of childhood illness","author":"World Health Organization Department of Child and Adolescent Health and Development","year":"2005","unstructured":"World Health Organization Department of Child and Adolescent Health and Development. Handbook IMCI: integrated management of childhood illness. World Health Organization, Dept. of Child and Adolescent Health and Development; 2005."},{"key":"7369_CR31","unstructured":"CLSI. Performance standards for antimicrobial susceptibility testing. CLSI Supplement M100. 31st ed. Malvern, PA: Clinical and Laboratory Standards Institute; 2021."},{"key":"7369_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30121-3","volume":"5","author":"TB Kortz","year":"2017","unstructured":"Kortz TB, Sawe H, Murray B, Matthay M, Reynolds T. Surviving paediatric sepsis in Tanzania: a prospective cohort study to identify risk factors. Lancet Glob Health. 2017;5:S14. https:\/\/doi.org\/10.1016\/S2214-109X(17)30121-3.","journal-title":"Lancet Glob Health"},{"issue":"12","key":"7369_CR33","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/S2352-4642(21)00286-8","volume":"5","author":"DC de Souza","year":"2021","unstructured":"de Souza DC, Gon\u00e7alves Martin J, Soares Lanziotti V, et al. The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study. Lancet Child Adolesc Health. 2021;5(12):873\u201381. https:\/\/doi.org\/10.1016\/S2352-4642(21)00286-8.","journal-title":"Lancet Child Adolesc Health"},{"issue":"1","key":"7369_CR34","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0773-4","volume":"19","author":"AL Conroy","year":"2015","unstructured":"Conroy AL, Hawkes M, Hayford K, et al. Prospective validation of pediatric disease severity scores to predict mortality in Ugandan children presenting with malaria and non-malaria febrile illness. Crit Care. 2015;19(1):47. https:\/\/doi.org\/10.1186\/s13054-015-0773-4.","journal-title":"Crit Care"},{"issue":"1","key":"7369_CR35","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1097\/CCM.0000000000005294","volume":"50","author":"K Menon","year":"2022","unstructured":"Menon K, Schlapbach LJ, Akech S, et al. Criteria for pediatric sepsis\u2014a systematic review and meta-analysis by the Pediatric Sepsis Definition Taskforce*. Crit Care Med. 2022;50(1):21. https:\/\/doi.org\/10.1097\/CCM.0000000000005294.","journal-title":"Crit Care Med"},{"issue":"4","key":"7369_CR36","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1001\/jamapediatrics.2018.4839","volume":"173","author":"B Tan","year":"2019","unstructured":"Tan B, Wong JJM, Sultana R, et al. Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(4):352\u201362. https:\/\/doi.org\/10.1001\/jamapediatrics.2018.4839.","journal-title":"JAMA Pediatr"},{"issue":"1S Suppl 1","key":"7369_CR37","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/SHK.0000000000000699","volume":"47","author":"DC de Souza","year":"2017","unstructured":"de Souza DC, Barreira ER, Faria LS. The epidemiology of sepsis in childhood. Shock. 2017;47(1S Suppl 1):2\u20135. https:\/\/doi.org\/10.1097\/SHK.0000000000000699.","journal-title":"Shock"},{"issue":"11","key":"7369_CR38","doi-asserted-by":"publisher","first-page":"e1029","DOI":"10.1097\/CCM.0000000000003351","volume":"46","author":"SY Irving","year":"2018","unstructured":"Irving SY, Daly B, Verger J, et al. The association of nutrition status expressed as body mass index z score with outcomes in children with severe sepsis: a secondary analysis from the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study*. Crit Care Med. 2018;46(11):e1029. https:\/\/doi.org\/10.1097\/CCM.0000000000003351.","journal-title":"Crit Care Med"},{"key":"7369_CR39","unstructured":"United Nations Children's Fund (UNICEF). Outliers and biologically-implausible values in population-based anthropometric surveys. Research Agenda Brief. New York: UNICEF; 2026."},{"issue":"23","key":"7369_CR40","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1056\/NEJMoa1703058","volume":"376","author":"CW Seymour","year":"2017","unstructured":"Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376(23):2235\u201344. https:\/\/doi.org\/10.1056\/NEJMoa1703058.","journal-title":"N Engl J Med"},{"key":"7369_CR41","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.jcrc.2020.07.027","volume":"60","author":"B Hu","year":"2020","unstructured":"Hu B, Xiang H, Dong Y, Portner E, Peng Z, Kashani K. Timeline of sepsis bundle component completion and its association with septic shock outcomes. J Crit Care. 2020;60:143\u201351. https:\/\/doi.org\/10.1016\/j.jcrc.2020.07.027.","journal-title":"J Crit Care"},{"issue":"12","key":"7369_CR42","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/medicina59122195","volume":"59","author":"A Massele","year":"2023","unstructured":"Massele A, Rogers AM, Gabriel D, et al. A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications. Medicina. 2023;59(12):12. https:\/\/doi.org\/10.3390\/medicina59122195.","journal-title":"Medicina"},{"issue":"10","key":"7369_CR43","doi-asserted-by":"publisher","first-page":"2646","DOI":"10.21037\/tp-20-310","volume":"10","author":"S Ranjit","year":"2021","unstructured":"Ranjit S, Kissoon N. Challenges and solutions in translating sepsis guidelines into practice in resource-limited settings. Transl Pediatr. 2021;10(10):2646\u201365. https:\/\/doi.org\/10.21037\/tp-20-310.","journal-title":"Transl Pediatr"},{"issue":"6","key":"7369_CR44","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s40290-024-00538-7","volume":"38","author":"RK Bhandari","year":"2024","unstructured":"Bhandari RK, Pandey AK, Malhotra S, et al. Addressing challenges in antibiotic access: barriers, implications and strategies for solution. Pharm Med. 2024;38(6):387\u201397. https:\/\/doi.org\/10.1007\/s40290-024-00538-7.","journal-title":"Pharm Med"},{"issue":"10","key":"7369_CR45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0291387","volume":"18","author":"P Ekyaruhanga","year":"2023","unstructured":"Ekyaruhanga P, Nantanda R, Aanyu HT, et al. Delay in healthcare seeking for young children with severe pneumonia at Mulago National Referral Hospital, Uganda: a mixed methods cross-sectional study. PLoS ONE. 2023;18(10):e0291387. https:\/\/doi.org\/10.1371\/journal.pone.0291387.","journal-title":"PLoS ONE"},{"issue":"4","key":"7369_CR46","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1097\/CCM.0000000000004769","volume":"49","author":"F Muttalib","year":"2021","unstructured":"Muttalib F, Gonz\u00e1lez-Dambrauskas S, Lee JH, et al. Pediatric Emergency and Critical Care Resources and Infrastructure in Resource-Limited Settings: A Multicountry Survey. Crit Care Med. 2021;49(4):671\u201381. https:\/\/doi.org\/10.1097\/CCM.0000000000004769.","journal-title":"Crit Care Med"},{"key":"7369_CR47","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-13110-z","author":"A Fasina-Ayoola","year":"2025","unstructured":"Fasina-Ayoola A, Adeyeye A, Tupetz A, et al. Applying the three delays qualitative model to sepsis care seeking and emergency care in a private hospital in Lagos, Nigeria. BMC Health Serv Res. 2025. https:\/\/doi.org\/10.1186\/s12913-025-13110-z.","journal-title":"BMC Health Serv Res"},{"issue":"8","key":"7369_CR48","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1111\/j.1365-3156.2010.02557.x","volume":"15","author":"P Waiswa","year":"2010","unstructured":"Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW. Using the three delays model to understand why newborn babies die in eastern Uganda. Tropical Med Int Health. 2010;15(8):964\u201372. https:\/\/doi.org\/10.1111\/j.1365-3156.2010.02557.x.","journal-title":"Tropical Med Int Health"},{"issue":"8","key":"7369_CR49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0000657","volume":"2","author":"EM Keating","year":"2022","unstructured":"Keating EM, Sakita F, Mmbaga BT, et al. Three delays model applied to pediatric injury care seeking in Northern Tanzania: a mixed methods study. PLoS Glob Public Health. 2022;2(8):e0000657. https:\/\/doi.org\/10.1371\/journal.pgph.0000657.","journal-title":"PLoS Glob Public Health"},{"issue":"2","key":"7369_CR50","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/S2352-4642(21)00341-2","volume":"6","author":"DC Souza","year":"2022","unstructured":"Souza DC, Jaramillo-Bustamante JC, C\u00e9spedes-Lesczinsky M, et al. Challenges and health-care priorities for reducing the burden of paediatric sepsis in Latin America: a call to action. The Lancet Child & Adolescent Health. 2022;6(2):129\u201336. https:\/\/doi.org\/10.1016\/S2352-4642(21)00341-2.","journal-title":"The Lancet Child & Adolescent Health"},{"issue":"8","key":"7369_CR51","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1001\/jama.2024.0196","volume":"331","author":"LN Sanchez-Pinto","year":"2024","unstructured":"Sanchez-Pinto LN, Bennett TD, DeWitt PE, et al. Development and validation of the Phoenix criteria for pediatric sepsis and septic shock. JAMA. 2024;331(8):675. https:\/\/doi.org\/10.1001\/jama.2024.0196.","journal-title":"JAMA"},{"issue":"12","key":"7369_CR52","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1086\/648409","volume":"200","author":"R Helbok","year":"2009","unstructured":"Helbok R, Kendjo E, Issifou S, et al. The Lambar\u00e9n\u00e9 organ dysfunction score (LODS) is a simple clinical predictor of fatal malaria in African children. J Infect Dis. 2009;200(12):1834\u201341. https:\/\/doi.org\/10.1086\/648409.","journal-title":"J Infect Dis"},{"issue":"1","key":"7369_CR53","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-7-500","volume":"7","author":"J Manyahi","year":"2014","unstructured":"Manyahi J, Matee MI, Majigo M, Moyo S, Mshana SE, Lyamuya EF. Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili national hospital, Tanzania. BMC Res Notes. 2014;7(1):500. https:\/\/doi.org\/10.1186\/1756-0500-7-500.","journal-title":"BMC Res Notes"},{"issue":"1","key":"7369_CR54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-017-2395-8","volume":"17","author":"J Manyahi","year":"2017","unstructured":"Manyahi J, Moyo SJ, Tellevik MG, et al. Detection of CTX-M-15 beta-lactamases in Enterobacteriaceae causing hospital- and community-acquired urinary tract infections as early as 2004, in Dar es Salaam. Tanzania BMC Infect Dis. 2017;17(1):1\u20137. https:\/\/doi.org\/10.1186\/s12879-017-2395-8.","journal-title":"Tanzania BMC Infect Dis"},{"issue":"3","key":"7369_CR55","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0220424","volume":"15","author":"J Manyahi","year":"2020","unstructured":"Manyahi J, Kibwana U, Mgimba E, Majigo M. Multi-drug resistant bacteria predict mortality in bloodstream infection in a tertiary setting in Tanzania. PLoS ONE. 2020;15(3):e0220424. https:\/\/doi.org\/10.1371\/journal.pone.0220424.","journal-title":"PLoS ONE"},{"key":"7369_CR56","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.02118","author":"SJ Moyo","year":"2020","unstructured":"Moyo SJ, Manyahi J, Blomberg B, et al. Bacteraemia, malaria, and case fatality among children hospitalized with fever in Dar es Salaam, Tanzania. Front Microbiol. 2020. https:\/\/doi.org\/10.3389\/fmicb.2020.02118.","journal-title":"Front Microbiol"},{"issue":"4","key":"7369_CR57","doi-asserted-by":"publisher","first-page":"767","DOI":"10.4269\/ajtmh.25-0522","volume":"114","author":"TB Kortz","year":"2026","unstructured":"Kortz TB, Chu VT, Mussa RY, et al. Prospective genomic surveillance of severe febrile illness in Tanzanian children identifies high mortality and resistance to first-line antibiotics in bloodstream infections. Am J Trop Med Hyg. 2026;114(4):767\u201373. https:\/\/doi.org\/10.4269\/ajtmh.25-0522.","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"7369_CR58","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1186\/s12879-025-11629-4","volume":"25","author":"SJ Moyo","year":"2025","unstructured":"Moyo SJ, Manyahi J, Aboud S, et al. Extended-spectrum-\u03b2-lactamase-producing Gram-negative bacteria are associated with high mortality in children with bloodstream infections in Dar es Salaam, Tanzania. BMC Infect Dis. 2025;25(1):1416. https:\/\/doi.org\/10.1186\/s12879-025-11629-4.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"7369_CR59","doi-asserted-by":"publisher","DOI":"10.1186\/cc9410","volume":"15","author":"I Baelani","year":"2011","unstructured":"Baelani I, Jochberger S, Laimer T, et al. Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers. Crit Care. 2011;15(1):R10. https:\/\/doi.org\/10.1186\/cc9410.","journal-title":"Crit Care"},{"key":"7369_CR60","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.socscimed.2017.01.032","volume":"177","author":"FE Aboud","year":"2017","unstructured":"Aboud FE, Rahman E, Kassam R, Khan J, Ali NA, Taleb F. Interrupting pathways to sepsis: effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh. Soc Sci Med. 2017;177:269\u201377. https:\/\/doi.org\/10.1016\/j.socscimed.2017.01.032.","journal-title":"Soc Sci Med"},{"issue":"8","key":"7369_CR61","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","volume":"147","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573\u20137. https:\/\/doi.org\/10.7326\/0003-4819-147-8-200710160-00010.","journal-title":"Ann Intern Med"}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-026-07369-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-026-07369-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-026-07369-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:45:06Z","timestamp":1792629906000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-026-07369-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":61,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7369"],"URL":"https:\/\/doi.org\/10.1186\/s12887-026-07369-2","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"assertion":[{"value":"18 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Muhimbili University of Health and Allied Sciences (MUHAS) (DA.282\/298\/01.C\/374), Tanzanian National Institute for Medical Research (NIMR) (NIMR\/HQ\/R.8a\/Vol. IX\/3576), and University of California, San Francisco (19\u201327627) Institutional Review Boards. The study followed STROBE reporting guidelines (Additional file 9).Potential participants were identified using consecutive sampling upon presentation to the EMD, and consent was obtained from the parent or guardian by trained research personnel. Participants assented when developmentally and cognitively able.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1050"}}