Perceptions of vasopressors and barriers to administration in Tanzanian hospitals

Abstract

Background:  

Sepsis carries a high mortality in Sub-Saharan Africa (SSA). Current international guidelines advocate for fluid boluses in the initial resuscitation of patients with sepsis followed by vasopressors if there is ongoing concern for hypoperfusion. Emerging data suggest patients in SSA who receive large fluid boluses may have increased mortality, and that earlier administration of vasopressors may have clinical benefit. Little regional data is available on the feasibility of this strategy in terms of provider’s comfort with vasopressors and barriers to their administration. The goal of our study was to describe subjective perceptions of vasopressors including barriers to their administration among Tanzanian clinicians who treat septic shock.

Methods: We conducted a cross-sectional web-based survey of clinical staff (physicians and nurses) in hospitals throughout Tanzania. Survey questions were presented in English and Swahili. Results were summarized with descriptive statistics. 

Results: Sixty-five providers completed the survey from 19 different hospitals throughout Tanzania, including district, regional, zonal and national hospitals. The majority agreed with the statements, “vasopressors are a needed class of medications to have on hand at my facility” (93.8%) and “vasopressors are generally safe medications with few complications” (81.5%). Most respondents (78.4%) disagreed that “septic shock can usually be treated with fluids alone, and I have little use for vasopressors in septic shock.” The most common reported barrier was lack of availability(50.8%), followed by lack of comfort with these medications (43.1%).

Conclusions: Nearly all Tanzanian clinicians surveyed feel that vasopressors are safe and necessary tools to treat septic shock.  In addition to lack access, lack of comfort with vasopressors was reported as a barrier to administration. Our findings suggest that improving access to these generally low-cost medications and further education to improve providers’ comfort using them would improve the ability to treat septic shock in many Tanzanian hospitals.