Survey Reveals Shortcomings in Critical Care for Patients in African Hospitals

In numerous African nations, the healthcare system is failing to adequately support critically ill patients, primarily due to the scarcity of intensive care units (ICUs). Instead of receiving specialized care, these patients often find themselves in general hospital wards, where access to essential emergency and critical care is severely limited.

Critical illness encompasses any serious condition where at least one vital organ, such as the heart, lungs, or brain, is not functioning properly. This can result from various causes, including infections, injuries, and non-communicable diseases like heart attacks or strokes, affecting individuals across all age groups.

In high-resource settings, critically ill patients benefit from intensive care units, where they receive continuous monitoring and life-saving treatments, such as oxygen support and medications to stabilize blood pressure. However, previous research on critical illness in Africa has primarily stemmed from small-scale studies, which, while suggestive of a pressing issue, lacked a comprehensive continental overview.

To address this gap, a collaborative group of clinical researchers conducted the African Critical Illness Outcomes Study. This large-scale investigation aimed to provide a clearer picture of critical illness care across Africa, building upon a network of clinicians, researchers, and policymakers dedicated to improving the identification and treatment of critically ill patients.

The findings, published in a respected medical journal, reveal alarming statistics: one in eight hospital inpatients in Africa is critically ill, with over two-thirds receiving treatment outside of ICUs. Furthermore, one in five of these patients dies within a week of admission, and many are deprived of the essential emergency and critical care that could potentially save their lives.

The study, which assessed the conditions of 20,000 patients across 180 hospitals in 22 African countries, provided significant insights:

• 12.5% of hospital inpatients were critically ill.
• 69% of these critically ill patients were treated in general wards rather than intensive care units.
• More than half of the critically ill patients did not receive necessary treatments.
• Critically ill patients were found to be eight times more likely to die in hospitals compared to other patients.

Moreover, the study highlighted considerable deficiencies in basic life-saving interventions:

• Only 48% of patients suffering from respiratory failure received oxygen therapy.
• 54% of patients with circulatory failure received fluids or medications to stabilize blood pressure.
• Fewer than half of patients with dangerously low levels of consciousness received appropriate airway protection or were positioned correctly to ensure safety.

These findings underscore a critical need for improved access to essential emergency and critical care across African hospitals. Simple, low-cost interventions could significantly increase survival rates among critically ill patients. Recommended measures include:

• Ensuring the availability of oxygen for patients facing respiratory challenges.
• Providing fluids or medications to stabilize blood pressure.
• Training healthcare workers in basic life-support techniques to effectively manage unconscious patients.

Unlike the high-tech treatments typically found in ICUs, these fundamental emergency and critical care measures can be implemented in general wards with minimal resources. Strengthening these systems could lead to a significant reduction in preventable deaths resulting from conditions like pneumonia, sepsis, and trauma.

Urgent action from governments and health organizations is essential. African governments are urged to incorporate essential emergency and critical care into universal health coverage, while the World Health Organization should promote these measures within its resolutions. Additionally, funding bodies should support research and implementation efforts focused on these critical care strategies.

The establishment of the Essential Emergency and Critical Care Network aims to foster collaboration and knowledge sharing to help reduce unnecessary fatalities.