Work overview

Section 02 of 12

Introduction

Implementing early warning systems for sepsis recognition in African healthcare settings: an Angolan perspective

Esmael Tomás and Ndenga Tomás · 2026

Contents

Section 02 of 12

  1. 01African relevance
  2. 02Introduction
  3. 03Early warning scores as tools for early sepsis recognition
  4. 04Operational realities and implementation challenges
  5. 05Examples of African implementation experiences
  6. 06Early warning scores as health-system interventions: lessons from Africa
  7. 07Implications for global sepsis strategies
  8. 08Conclusion
  9. 09Declarations
  10. 10Funding
  11. 11CRediT authorship contribution statement
  12. 12Declaration of competing interest
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Work overview

Section 2 of 12

Introduction

Esmael Tomás and Ndenga Tomás · about 1 minutes

Original source ↗

Sepsis remains one of the leading causes of critical illness and in-hospital mortality worldwide, disproportionately affecting low- and middle-income countries (LMICs), particularly across sub-Saharan Africa, where healthcare systems continue to develop under significant workforce and infrastructure constraints [[1], [2], [3], [4]]. Delayed recognition of clinical deterioration, limited access to intensive care resources, shortages of trained personnel, and inconsistent physiological monitoring continue to contribute to avoidable morbidity and mortality [[4], [5], [6], [7]].

The publication of the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 further reinforces the central role of early identification, timely escalation, and rapid therapeutic intervention in improving survival [1]. These recommendations are especially relevant to African emergency departments, where patients often present late, emergency units are overcrowded and monitoring resources are limited [3,8,9]. Under these circumstances, pragmatic approaches that support rapid recognition of deterioration may substantially improve patient outcomes [5,8].

Early Warning Scores (EWS) provide a structured method for identifying physiological deterioration using routinely collected vital signs. However, an important question remains: how can early recognition strategies be operationalised effectively in healthcare systems with major structural limitations?

Across many African hospitals, high patient volumes, limited staffing and intermittent physiological monitoring restrict the timely recognition and escalation of clinical deterioration [[5], [6], [7]]. Consequently, the success of sepsis recognition strategies depends not only on clinical knowledge, but also on whether deterioration-recognition systems can be implemented reliably within routine clinical workflows [[5], [6], [7]].

This commentary examines how EWS can be integrated into routine emergency and acute care across diverse African healthcare settings, drawing on emerging evidence and lessons from Angola to identify practical approaches for strengthening early recognition of sepsis.