High prevalence of critically ill patients dying in African hospitals

A new research study conducted by scholars at the University of Cape Town (UCT), in collaboration with international partners, revealed that an alarming number of patients admitted to hospitals across Africa are critically ill and die before they receive the treatment they need.

Approximately 12.5% of in-hospital patients on the continent are gravely ill. This number equates to roughly one in eight individuals. In addition, 21% of these patients die within seven days of admission, compared to 2.7% who are not critically ill.

The research study, titled “The African critical illness outcome study: a point prevalence study of critical illness in 22 nations in Africa (ACIOS)” was conducted by the African Perioperative Research Group (APORG) and published in The Lancet – a leading peer-reviewed journal. The study was conducted in partnership with UCT, Muhimbili University of Health and Allied Sciences in Tanzania, Queen Mary University of London, and The Essential Emergency and Critical Care (EECC) Network.

High mortality rate among critically ill patients

The ACIOS was funded by the National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care, and it is the first African-wide epidemiological study of critical care illness.

“Critical illness can be defined as a state of ill health with vital organ dysfunction and a high risk of imminent death if care is not provided.”

In summary, the study found an alarmingly high rate of critically ill patients in hospitals across the continent. The burden of critical illness in hospital patients was also approximately 25% higher than reported in a similar high-income country study.

To draw the necessary conclusions, researchers used data from close to 20 000 patients across 180 hospitals in 22 countries on the continent. Patients were classified as critically ill if their vital signs were severely unstable and followed up on for seven consecutive days to assess their outcome.

“Critical illness can be defined as a state of ill health with vital organ dysfunction [with] a high risk of imminent death if care is not provided,” said Professor Bruce Biccard of UCT’s Department of Anaesthesia and Perioperative Medicine and the co-principal lead of the Global Health Group in Perioperative and Critical Care.

A shortage of resources

Professor Biccard said the study also found that 69% of critically ill patients are cared for in general hospital wards, rather than in high-dependency or intensive care units. And more than half of critically ill patients surveyed did not receive essential, emergency, lifesaving critical care like oxygen, intravenous fluids and correct positioning.

He said the research demonstrates that hospitals across Africa struggle with dire resource shortages like infrastructure, equipment, staff, training, treatment guidelines, consumables and drugs – all necessary to treat critically ill patients effectively.

“Our findings suggest a high incidence of preventable deaths from critical illness in Africa.”

“Our findings suggest a high incidence of preventable deaths from critical illness in Africa. In many cases, the provision of basic critical care through the equitable and systems-based implementation of essential emergency and critical care may have substantial impact on these preventable patient deaths,” he said.