Survey Reveals Critical Care Gaps in African Hospitals

A recent survey highlights alarming deficiencies in the treatment of critically ill patients across various hospitals in Africa. While hospitals are expected to provide life-saving care for individuals experiencing severe health crises, a significant number of these patients are being treated in general wards rather than specialized intensive care units (ICUs), which are often scarce in the region.

Critical illness encompasses any life-threatening condition that involves the failure of one or more vital organs, such as the heart, lungs, or brain. These conditions may arise from a range of underlying issues, including infections, injuries, and non-communicable diseases like heart attacks and strokes. In higher-resource settings, critically ill patients typically receive comprehensive care in ICUs, including constant monitoring, oxygen therapy, and medications to stabilize their conditions. However, data on critical care across Africa has largely stemmed from smaller studies conducted in individual hospitals, which suggested a pressing issue.

For instance, research in Uganda indicated that 11.7% of hospitalized patients were critically ill, with a 22.6% risk of mortality within a week. Nevertheless, a comprehensive assessment of the wider situation across the continent was lacking. This gap prompted a collaborative initiative among clinical researchers in Africa to undertake the African Critical Illness Outcomes Study, marking the first extensive investigation into critical illness care on the continent.

This study, published in The Lancet, offers significant insights. Findings reveal that one in eight hospitalized patients in Africa is critically ill, with over two-thirds receiving care in general wards instead of specialized ICUs. Alarmingly, one in five of these patients dies within a week of admission. A substantial portion of critically ill patients are not receiving essential emergency and critical care interventions that could potentially save their lives.

The study evaluated approximately 20,000 patients across 180 hospitals in 22 African countries, ranging from Tunisia in the north to South Africa in the south, and from Ghana in the west to Tanzania in the east. Conducted in late 2023, researchers collected data on patients' clinical conditions and treatments on a single day and tracked their outcomes one week later.

Key findings from the survey include:

• 12.5% of hospitalized patients were identified as critically ill.
• 69% of critically ill patients were treated in general wards rather than ICUs.
• More than half of these patients did not receive necessary treatments.
• Critically ill patients faced an eightfold increased risk of in-hospital mortality compared to other patients.

The study also pointed out significant gaps in life-saving interventions:

• Only 48% of patients experiencing respiratory failure received oxygen therapy.
• Just 54% of those in circulatory failure were administered fluids or medications to stabilize their blood pressure.
• Fewer than half of patients with severely reduced consciousness received appropriate airway protection or were positioned for recovery.

These findings underscore a critical and urgent need for improvement in the treatment of critically ill patients in Africa. The research suggests that many lives could be saved with better access to essential emergency and critical care services. These services comprise straightforward, low-cost interventions that can be administered even in resource-limited settings, including:

• Ensuring the availability of oxygen for patients struggling to breathe.
• Administering fluids or medications to stabilize blood pressure.
• Training healthcare workers in basic life-support techniques to manage unconscious patients.

Enhancing these systems could significantly decrease preventable deaths resulting from conditions such as pneumonia, sepsis, and trauma. The study calls for immediate action, advocating that African governments prioritize essential emergency and critical care as a fundamental component of universal health coverage. This care should be integrated into national health policies and benefit packages.

The World Health Organization is urged to incorporate essential emergency and critical care measures into its frameworks, while African health funders should support research and implementation initiatives. Moreover, professional medical societies must include these services in clinical guidelines and training programs to equip frontline healthcare workers with the necessary tools to save lives.

To further this cause, the EECC Network has been established as a global community focused on sharing knowledge, research, and best practices to prevent unnecessary fatalities.