New Study Improves the Prediction of Life-Threatening Infection in Children Across South and Southeast Asia

Led by researchers from Médecins Sans Frontières (MSF) and the University of Oxford’s Mahidol Oxford Tropical Medicine Research Unit (MORU), the "Spot Sepsis" study demonstrates that new prognostic tools vastly outperform current international standards for identifying which febrile children require urgent hospital referral.

In many remote communities, infectious diseases remain the leading cause of death for children under five, often because health workers lack the tools to recognise impending sepsis before it is too late.

The study found that the current World Health Organization (WHO) danger signs would have missed nearly half (44.5%) of the children who eventually progressed to death or required organ support. By contrast, the team's new models—which combine simple and accessible clinical signs with pulse oximetry or a blood test called sTREM1—would have identified approximately 89% of these high-risk children. Further, overall recommended referral rates using the new tools were projected to drop from 17% to less than 5%.

"MSF operates in remote and conflict-affected areas where reaching higher-level care is often irregular and fraught with difficulty. A simple, deployable tool that enables health workers in decentralised care settings to correctly identify children at high risk of sepsis would be invaluable,’ said Dr Sakib Burza, MSF Principal Investigator of the study. "Our results show that by using simple and accessible clinical signs, alongside tools like pulse oximetry or a rapid blood test, we could not only identify more sick children but also drastically reduce unnecessary referrals, ensuring limited hospital resources are reserved for those in greatest need", said Dr Arjun Chandna, the study's lead author.

Spot Sepsis is the largest study to date investigating the clinical utility of host biomarkers in the prognostication of childhood febrile illness and the first study conducted at the community-level. Between 2020 and 2022, the team followed 3,500 children across seven rural sites in Bangladesh, Cambodia, Indonesia, Laos, and Viet Nam. The study concludes that use of these tools could be highly cost-effective. "Compared to current WHO criteria, all these approaches are likely to be cost-saving, while strategies incorporating pulse oximetry or the host biomarker sTREM1 remain highly cost-effective compared to use of simple clinical signs alone", said Professor Yoel Lubell, health economist and Oxford Principal Investigator of the study. Pulse oximetry-based triage was projected to cost just $26.28 per life-year saved - underscoring a compelling case for future integration into humanitarian operations and primary care systems globally.

Spot Sepsis was funded by MSF and Wellcome.