Abstract
Sepsis remains a major cause of preventable mortality, particularly in low- and middle-income countries, where delayed recognition of clinical deterioration continues to contribute substantially to poor outcomes. The 2026 Surviving Sepsis Campaign guidelines reaffirm that early identification and timely intervention are key determinants of survival. However, implementing these recommendations in resource-limited African healthcare settings remains challenging. Early Warning Scores, including the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS) and NEWS2, provide simple bedside methods for detecting physiological deterioration using routinely collected vital signs. In many African healthcare environments, workforce shortages, limited monitoring capacity, overcrowding and constrained escalation pathways present important challenges to the reliable use of deterioration-recognition systems. Drawing on emerging African evidence, this commentary examines the opportunities and challenges associated with implementing Early Warning Systems for sepsis recognition in African emergency and acute care settings. We argue that the principal challenge is not modification of existing physiological scoring systems, but rather their sustainable integration into routine clinical practice. Future efforts should prioritise external validation studies, pragmatic health-systems research, workforce training and African-led research collaborations to strengthen the evidence base supporting Early Warning Systems across diverse healthcare environments. Improving sepsis outcomes in Africa will depend not only on recognising deterioration earlier, but also on ensuring that healthcare systems can respond effectively when deterioration is detected.