Introduction: Delayed recognition of pediatric sepsis contributes significantly to preventable mortality in low- and middle-income countries (LMICs), where access to facility-based care is often limited. Community-based tools—used by community health workers (CHWs), caregivers, or through mobile health (mHealth) platforms—aim to support early recognition and referral. The 2024 SCCM Pediatric Sepsis Definition Task Force introduced the Phoenix Sepsis Score as a global diagnostic standard, but noted that it is not intended as a pre-hospital screening tool. This review evaluates the effectiveness and feasibility of community-based sepsis screening tools in LMICs and explores their role in early recognition, system integration, and alignment with critical care frameworks.
Methods: We performed a systematic review in accordance with PRISMA 2020. PubMed, EMBASE, Scopus, CINAHL, and Global Health were searched from 2005 to March 2024. Included studies assessed pediatric ( < 18 years) sepsis or serious infection tools used in community or primary care settings in LMICs. Data on diagnostic performance, referral outcomes, training, and implementation challenges were extracted. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT).
Results: Eighteen studies met inclusion (Sub-Saharan Africa n=7; South Asia n=8; Latin America n=3). Tools—mostly CHW-administered checklists or mHealth apps based on WHO IMCI—demonstrated sensitivities of 65–95% and specificities of 50–90%. Referral rates increased 30–70%; four studies reported reductions in under-five mortality up to 40%. Although none incorporated the Phoenix Score, several tools supported early identification prior to organ dysfunction. Adaptability to local epidemiology, short training, and linkage to referral systems enhanced feasibility. Barriers included poor connectivity, CHW workload, and mistrust of urgent referrals.
Conclusions: Community-based screening tools complement Phoenix-based definitions by identifying at-risk children before clinical sepsis develops. When digitally enabled and context-adaptable, they offer a scalable path to early recognition and referral. Their integration with downstream Phoenix-based assessment and quality improvement initiatives supports a continuum of care for pediatric sepsis in LMICs.
