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Sumba Sepsis Study 2026: Risultati interattivi
The Sumba Sepsis Study 2026 turned months of fieldwork into evidence that can now be explored. See where infection prevention fails, where time is lost before care, what healthcare workers report, and which actions the findings now support.
Explore the results of the Sumba Sepsis Study 2026
1,001 households, 162 healthcare-worker submissions and one question: where is effective care being lost?
This page presents the most important results of the consolidated report in an interactive form. Start with the findings that require immediate attention, then explore the evidence by household, healthcare worker, locality and stage of the care pathway.
Il Sumba Sepsis Study film documents the people, roads and barriers to care behind the fieldwork.
Evidence that requires action
Six findings that are difficult to ignore
These are the headline results highlighted by the consolidated report. They describe material prevention gaps, delayed presentation, limited previous training and concerns about reliable treatment at first contact.
Household reports and healthcare-worker submissions. Not a sepsis prevalence estimate or an independently audited facility census. Report v1.0, p. 3.
No water and soap together at a handwashing place
950 of 998 household responses
About this result
This describes the reported absence of water and soap together at the household handwashing place. It does not mean that families never wash their hands, and the condition was not independently verified in every home.
HH-Q19 · Report p. 13
Staff reported patients arriving late in advanced condition
158 of 162 healthcare-worker submissions said this occurs at least sometimes
About this result
This is a healthcare-worker questionnaire result. It does not mean that 97.5% of patients arrive late and is not a patient-level rate.
HW-Q21 · Report p. 20
No previous sepsis or severe-infection training
144 of 162 healthcare-worker submissions
About this result
The finding documents reported prior topic-specific training. It is not a direct assessment of individual clinical competence.
Healthcare-worker survey · Report p. 18
Injectable antibiotics were not always available in primary care
70 of 105 primary-care submissions reported sometimes, rarely or never
About this result
These are staff reports, not audited stock records or percentages of health facilities. They identify concern about reliable treatment at first contact.
Healthcare-worker survey · Report p. 19
Households faced prevention and access barriers at the same time
Every household reporting at least one hour to formal care also lacked water and soap together
About this result
The same 286 household records carried both findings. This is a descriptive overlap, not evidence that one barrier caused the other.
HH-Q20 + HH-Q19 · Report p. 14
No toilet or open defecation reported
401 of 996 household responses
About this result
Simple pit latrines were not classified as open defecation. Construction quality was not assessed.
HH-Q18 · Report p. 13
The study in numbers
The 4,977 usual residents were recorded across 992 households with household-size data. They were not individually interviewed or clinically examined. Nine household-size answers were missing. Report p. 7.
How to read these results
The study describes a chain of vulnerability
Months of preparation, household visits, healthcare-worker questionnaires, data review and clinical interpretation produced a baseline showing where prevention, access, first-contact care, referral and outcome recording are incomplete.
Q23 · Illness and recognition
When illness becomes normal
A symptom can become familiar without becoming harmless.
Reported an illness or infection becoming severe or frightening in the previous six months.
What does a family call serious illness?
The survey recorded household experience, not a diagnosis. Field accounts describe families for whom recurrent cough, diarrhoea, weakness or skin infection had become familiar parts of daily life. In those accounts, serious illness could mean hospitalisation, extreme deterioration or death.
These observations raise a concern about under-recognition. The study does not quantify how often it occurred.
HH-Q23 · Report pp. 15 and 26 · Field observations are distinct from the numerical result.
249 households
Reported a severe or frightening illness.
752 households
Did not report such an episode. This does not establish that they were free from illness.
24.9% is not sepsis prevalence and is not the percentage of households that normalise illness. The reported result and the field observations answer different questions. Neither provides a corrected estimate of unrecognised illness.
What the survey recorded
Q23 asked about an illness or infection becoming severe or frightening within six months. The 249 positive answers count households reporting that experience, not individual sick people, all illness episodes or clinically confirmed sepsis.
Persistent symptoms can warrant assessment without automatically constituting severe illness or sepsis. Answering No does not establish that a household was free from illness.
Technical note: the earlier 0% dashboard display
The former 0% display was a calculation error caused by reading the wrong column. The corrected recorded result is 249 of 1,001 households (24.9%). Correcting that display does not measure unrecognised or unreported illness. These are separate issues.
What our teams observed
Study leadership and the post-fieldwork debrief described families living with familiar, repeated symptoms. In those accounts, illness might not be described as serious until hospitalisation or extreme deterioration, even when symptoms had lasted for weeks.
A memo dated 17 June 2026, issued from Rumah Kambera during fieldwork, asked enumerators to explore negative Q23 answers carefully. It prompted recall of symptoms, deterioration and loss of normal function.
The memo's duration-based examples extended the original prompts. Consistent use and the effect on answers were not measured. The accounts make under-recognition plausible, but do not identify which negative responses would change or establish a causal link with delay.
What this changes in practice
The response is not to blame families. Future assessment should ask about symptoms, duration, deterioration and loss of normal function, rather than rely only on the word serious.
Better recognition must connect to accessible clinical assessment and practical help. Advice does not provide a vehicle, pay for the journey or ensure that a service can respond when a patient arrives. A duration threshold alone is not a sepsis definition.
Families should not have to wait for hospitalisation or extreme deterioration before illness is taken seriously.
Read the discussion: report p. 26 (English PDF, new tab). Numerical result: p. 15; analytical rules: pp. 10-11 and 31.
What the study delivered
What your support made possible
Your support helped turn months of fieldwork into documented findings: 1,001 household interviews, 162 healthcare-worker submissions and a review of the administrative material supplied to the project.
The work documented prevention gaps, barriers to care, reported treatment-readiness concerns and weaknesses in outcome recording. It provides a basis for targeted work and for checking what changes next.
This is an evidence baseline, not a demonstrated improvement in survival. The next test is whether prevention becomes practical, care becomes reachable and the necessary treatment is available when a patient needs it.
Report pp. 7-12 and 27-29 · Programme effects require prospective evaluation.
Explore the evidence
Three views of the same care system
Household interviews describe living conditions and access. Healthcare-worker questionnaires describe professional experience and reported readiness. Administrative records show what the available system data can, and often cannot, establish.
What households reported
The household survey shows that infection prevention is constrained before illness even begins. Of the 998 households answering the handwashing question, 752 reported no handwashing place at all. Another 198 reported only water or only soap. Only 48 reported both water and soap together.
The same dataset describes substantial access pressure. 286 of 997 households reported at least one hour to formal care, including 71 reporting more than two hours. 308 of 993 reported more than 10 km. Motorbikes were the usual way of reaching care for 924 of 999 responses.
Reaching care also depends on the moment a household seeks help. Only 452 of 999 responses described same-day outside help after illness became serious. Another 422 selected the next day. Separately, 475 of 985 households reported buying non-prescription medicine before formal care.
Q23 records reported household experience, not clinically confirmed sepsis. Timing questions are not consistently linked to the same severe-illness episode. Household percentages describe this sample and cannot be directly applied to the whole population of East Sumba. The 48.2% medicine-purchase result does not measure antibiotic misuse or resistance: drug class, dose and indication were not reliably established. Report p. 17.
What healthcare workers reported
The 162 professional submissions show an important distinction between confidence and formal preparation. 96 respondents reported full confidence and 57 partial confidence, but 144 reported no previous training specifically on sepsis or severe infection. In primary care, that training gap was reported by 96 of 105 respondents.
The study also found useful existing capacity. In primary care, 92 of 105 submissions reported oxygen available, 101 reported IV fluids, and 95 reported basic monitoring. These resources provide a base to build on.
Reliability becomes the central issue. Only 35 of 105 primary-care submissions reported injectable antibiotics as always available. Access to blood culture and basic haematology was reported much less often than oxygen, fluids or monitoring. This argues for verification of the full clinical chain rather than procurement of one isolated device.
The unit is a questionnaire submission, not an independently audited facility. Several staff may describe the same establishment. Self-reported confidence is not a formal assessment of clinical competence.
What the supplied administrative records could not reliably show
The administrative infection workbook listed 28 facilities: four hospitals and 24 Puskesmas. It contained non-zero values, but most potential infection entries were recorded as zero: 232 of 308 in 2025 and 228 of 308 in 2026.
Seven of eleven diagnostic categories were zero at every listed facility in both years. Referral counts were supplied for only two of the 24 Puskesmas. Without definitions for zero, reporting completeness, denominators and the 2026 cut-off, these records cannot establish district severe-infection burden or infection-attributable mortality.
A separate capacity return was also incomplete. All four staffing counts were present for only 11 of 28 rows, basic monitoring equipment was filled in for one row, and referral-transport quantity for 11. The form also contained an unresolved future date.
Follow the care pathway
Where can time and safety be lost?
The household and healthcare-worker surveys concern different people and are not linked patient histories. Their findings nevertheless reveal weaknesses at several consecutive stages between prevention in the home and a documented clinical outcome.
Prevent infection before deterioration begins
Infection prevention begins with material conditions. 950 of 998 households did not report water and soap together at a handwashing place, while 401 of 996 reported no toilet or open defecation. 257 of 999 reported an open well, surface water, river or stream as their main water source.
Education remains useful, but a health message cannot supply water, soap, sanitation or a safer water source. The study therefore identifies prevention as both a behavioural and an infrastructure problem.
Report pp. 13-14
Recognise deterioration early enough to act
249 of 1,001 households reported an illness or infection becoming severe or frightening during the previous six months. The questionnaire used examples such as marked weakness, breathing difficulty, reduced responsiveness and convulsions.
During fieldwork, the team documented concern that recurrent cough, diarrhoea, weakness or skin infection could become familiar enough that a family might not describe illness as serious until extreme deterioration occurred. That concern is plausible but was not measured as a prevalence of beliefs.
Explore Q23: when illness becomes normal
Report pp. 15 and 26
Wanting care does not guarantee timely help
Reported full or some confidence in formal healthcare.
Described seeking outside help on the same day.
Trust and timely access are different measures. Different questions and denominators; the same episode and starting point were not verified across all timing answers. These are not a linked patient timeline or a verified time-to-treatment distribution. Report p. 17.
Full or some confidence in formal care was reported by 993 of 995 households. Trust therefore appears high in the sampled households. Yet only 452 of 999 responses described outside help on the same day after illness became serious. Another 422 selected the next day.
Distance or unavailable transport was mentioned in 686 of 969 responses to the barriers question and transport or treatment cost in 665. Non-prescription medicine purchase before formal care was reported by 475 of 985 households.
Report p. 17
The first journey can already be long
286 of 997 households reported at least one hour to the nearest formal health facility. 71 reported more than two hours, and 308 of 993 reported more than 10 km.
Motorbikes were the usual means of reaching care in 924 of 999 responses. Forty reported walking and 33 reported no reliable transport. No household selected an ambulance as its usual transport mode, although this does not measure emergency ambulance availability.
Report p. 14
First-contact readiness was reported as uneven
144 of 162 healthcare-worker submissions reported no previous training on sepsis or severe infection. In primary care, that applied to 96 of 105 submissions.
Existing resources should not be ignored. Oxygen, IV fluids and basic monitoring were reported by most primary-care respondents. The concern is reliability across the whole package: only 35 of 105 reported injectable antibiotics as always available, while unrestricted laboratory access and basic haematology were reported less consistently.
Report pp. 18-19
Referral barriers occur at several points
Among the 137 healthcare-worker submissions from respondents who refer severe patients, delay in decision-making was selected by 83, distance by 71, receiving-facility overcrowding by 56 and cost by 48. Lack of staff, terrain and absence of transport were also reported.
The study does not identify whose decision was delayed, and these barriers overlap. A low percentage selecting "no transport" therefore does not prove that transport was adequate: cost, distance and terrain may describe related problems.
Multiple selections possible · Report p. 20
Recovery and outcome need better follow-up
63 of 246 selected episodes involved incomplete recovery or lasting weakness/disability.
54 were reported as still ill or not fully recovered; nine involved permanent weakness or disability. Outcome answers were available for 246 of 249 eligible households.
HH-Q32 · Report p. 16. These are reported outcomes, without clinical or longitudinal adjudication. They do not establish post-sepsis syndrome or a complication rate after confirmed sepsis.
Among selected severe-illness episodes with an outcome answer, 54 of 246 were still ill or not fully recovered and nine involved permanent weakness or disability. Together, 63 of 246 involved incomplete recovery or lasting weakness.
These household reports do not establish post-sepsis syndrome. More importantly for the health system, the supplied administrative referral data did not reliably connect severe illness, transfer and final outcome.
Report pp. 16 and 22
Household conditions and prevention
Explore the conditions families live with
Compare one indicator across the eight study localities. Every result retains its own numerator and denominator. These are reported conditions in the interviewed households, not population estimates or village sepsis-risk rankings.
Smoking inside the home
82.5% 814 of 987 household responses
14 missing answers out of 1,001 households. Someone regularly smoking indoors was reported by these households. This is not the percentage of people who smoke, a measured exposure level or a rate of illness caused by tobacco smoke.
Firewood mentioned for cooking
98.0% 974 of 994 household responses
7 missing answers out of 1,001 households. Includes answers mentioning firewood alongside another fuel. This does not mean exclusive firewood use and does not measure indoor pollution. This indicator supplements the published report tables.
HH-Q12 · Supplementary export analysis · 18 September 2026
Open well, surface water or river as main water source
25.7% 257 of 999 household responses
2 missing answers out of 1,001 households. Source categories describe reported water access. They are not microbiological test results and do not establish whether water was safe to drink.
No water treatment, with no other method selected
40.8% 406 of 995 household responses
6 missing answers out of 1,001 households. Only answers selecting no treatment alone are counted. Another 49 answers combined no treatment with boiling or filtering and remain a separate contradictory category.
Locality breakdowns above: supplementary descriptive analysis of the supplied household export, 18 September 2026. Missing answers are excluded from each denominator. Differences may reflect selection, household composition, recall or interviewing. The published report remains version 1.0.
View all four indicators in a table
| Locality | Smoking inside the home | Firewood mentioned for cooking | Open well, surface water or river as main water source | No water treatment, with no other method selected |
|---|---|---|---|---|
| Kawangu | 140/205 (68.3%) | 197/210 (93.8%) | 92/210 (43.8%) | 98/211 (46.4%) |
| Kambatatana | 50/88 (56.8%) | 88/90 (97.8%) | 22/90 (24.4%) | 23/89 (25.8%) |
| Mbatakapidu | 61/72 (84.7%) | 71/72 (98.6%) | 26/72 (36.1%) | 9/72 (12.5%) |
| Pambota Njara | 27/28 (96.4%) | 28/28 (100.0%) | 1/28 (3.6%) | 1/28 (3.6%) |
| Mbatapuhu | 185/196 (94.4%) | 196/196 (100.0%) | 6/199 (3.0%) | 125/195 (64.1%) |
| Napu | 85/98 (86.7%) | 97/98 (99.0%) | 15/99 (15.2%) | 48/99 (48.5%) |
| Mbinudita | 97/101 (96.0%) | 101/101 (100.0%) | 45/101 (44.6%) | 20/101 (19.8%) |
| Pulu Panjang | 169/199 (84.9%) | 196/199 (98.5%) | 50/200 (25.0%) | 82/200 (41.0%) |
Economic conditions, health and community support
Monthly household income below IDR 500,000
83.1%
829 of 997 responses · 4 missing
Household income, not income per person or an official poverty classification.
HH-Q4 · Report p. 13At least one chronic condition reported
30.0%
300 of 1001 responses · 0 missing
Household reports, including the other-condition category; diagnoses were not independently verified.
HH-Q9 · Report p. 13Recognised Kawan Sehat
37.3%
367 of 984 responses · 17 missing
Recognition of the programme name, not verified programme coverage.
HH-Q45 · Report p. 21Reported help from Kawan Sehat in the previous six months
35.3%
346 of 979 responses · 22 missing
Reported support, not evidence of an effect on survival or recovery.
HH-Q46 · Report p. 21Compare the study localities
The sample did not look the same everywhere
Select a locality to explore four descriptive indicators and a short interpretation. Locality differences may reflect morbidity, household composition, selection, recall, language or differences in interviewing. They are not village sepsis-risk rankings.
Kawangu
211 households interviewed
Household denominators differ where answers are missing. Q23 records reported severe or frightening illness and is not a sepsis diagnosis. Sample percentages cannot be directly applied to all residents of these localities.
View all eight locality results
| Study locality | Households interviewed | At least 1 hour to formal care | No toilet / open defecation | Water AND soap available | Severe or frightening illness reported (6 months) |
|---|---|---|---|---|---|
| Kawangu | 211 | 1.4% 3 of 211 |
31.3% 66 of 211 |
15.7% 33 of 210 |
28.9% 61 of 211 |
| Kambatatana | 90 | 0.0% 0 of 90 |
6.7% 6 of 90 |
13.5% 12 of 89 |
45.6% 41 of 90 |
| Mbatakapidu | 72 | 0.0% 0 of 72 |
26.4% 19 of 72 |
4.2% 3 of 72 |
8.3% 6 of 72 |
| Pambota Njara | 28 | 7.1% 2 of 28 |
85.2% 23 of 27 |
0.0% 0 of 28 |
0.0% 0 of 28 |
| Mbatapuhu | 200 | 57.1% 113 of 198 |
74.6% 147 of 197 |
0.0% 0 of 199 |
21.5% 43 of 200 |
| Napu | 99 | 71.1% 69 of 97 |
62.6% 62 of 99 |
0.0% 0 of 99 |
40.4% 40 of 99 |
| Mbinudita | 101 | 0.0% 0 of 101 |
26.7% 27 of 101 |
0.0% 0 of 101 |
49.5% 50 of 101 |
| Pulu Panjang | 200 | 49.5% 99 of 200 |
25.6% 51 of 199 |
0.0% 0 of 200 |
4.0% 8 of 200 |
Sample results, not population rates or a village sepsis-risk ranking. Water and soap describes a resource present, not absent. No Q23 episode reported does not establish absence of illness. Mbinudita and Praipaha are counted as one locality in the report.
Referral barriers
The problem is not only transport
Among 137 healthcare-worker submissions from staff who reported referring severe patients, several barriers could be selected. Decision-making, distance, receiving-facility capacity and cost were the most frequently selected.
Percentages are mentions, not shares of delay attributable to each cause, and do not need to sum to 100%. The question does not establish whose decision was delayed.
From evidence to action
Six priorities emerging from the study
These are proposed responses derived from the evidence. The study did not test their effectiveness. Each priority therefore includes a practical action and a way future progress could be measured.
1. Material prevention
Evidence behind this priority: 950 of 998 household responses reported no water and soap together at a handwashing place; 401 of 996 reported no toilet or open defecation. Report p. 13.
Verify and improve access to water and soap, safe sanitation and household water practices in priority settlements.
Measure: functioning handwashing place, water and soap availability, and sanitation use.
2. Recognition and first contact
Evidence behind this priority: 144 of 162 healthcare-worker submissions reported no previous sepsis or severe-infection training. Field accounts also raised concern about illness recognition, without quantifying under-recognition. Report pp. 18 and 26.
Build supervised, locally understandable danger-sign assessment and practical clinical skills.
Measure: demonstrated skills, appropriate escalation and missed deterioration on review.
3. Transport and referral
Evidence behind this priority: 286 of 997 households reported at least one hour to formal care. Among 137 staff submissions from those referring severe patients, 83 selected decision-making delay and 71 distance. Report pp. 14 and 20.
Clarify contact and acceptance arrangements, available drivers or vehicles, and support for families facing transport costs.
Measure: decision, departure and arrival times, completed transfer and recorded outcome.
4. Treatment readiness
Evidence behind this priority: 70 of 105 primary-care submissions described injectable antibiotics as available sometimes, rarely or never. These are staff reports, not independently audited stock records. Report p. 19.
Verify level-appropriate medicines, oxygen delivery, monitoring and trained shift coverage.
Measure: stock-out days, functional equipment, replenishment and staff coverage.
5. Diagnosis and safe medicine use
Evidence behind this priority: Blood-culture access was reported in 13 of 105 primary-care submissions, and basic haematology access in 32 of 105. These are reported resources, not verified availability for a specific patient. Report p. 19.
Clarify accessible tests, sample transport and clinician-led prescribing review.
Measure: usable results returned, treatment review and sample-transfer failures.
6. Count and follow severe illness
Evidence behind this priority: Referral counts were provided for only 2 of 24 Puskesmas in the supplied administrative workbook. Undefined zeros, reporting gaps and missing denominators prevent reliable burden or outcome estimates. Report p. 22.
Use defined categories and reporting periods, and distinguish zero, missing and not reported.
Measure: reporting completeness and reconciled severe episodes, transfers and outcomes.
Scientific safeguards
What these results can - and cannot - tell us
Read the full evidence
The complete 33-page report
The main results come from the consolidated post-fieldwork report published for World Sepsis Day 2026. The full methodology, denominators, limitations, administrative audit and sources remain available there.
Report version 1.0 · Consolidated post-fieldwork edition ·
13 September 2026 · Epidemiological interpretation remains preliminary.
Interface revision 4.0 · 18 September 2026. The underlying report and published results remain version 1.0.
