Results are presented of a retrospective audit of admissions to the Intensive Care Unit (ICU) of Kamuzu Central Hospital in Lilongwe, Malawi, which is a tertiary referral facility. The audit was conducted for a period of one year spanning from January to December, 2012. The objectives of the audit were to: describe the profile of admissions and treatment outcomes of the admissions and identify main causes of mortality in ICU of the facility. The admission book and patients' records were reviewed retrospectively guided by a data extraction form which was specifically designed for this study. The extracted data included age, sex, referring unit, diagnosis, treatment outcome and length of stay. The data were analyzed using STATA version 10.0. A total of 253 patients were admitted to the ICU over the one year period of study. About a third of the patients (33.6% n = 85) were admitted due to postoperative surgery. There were 154 deaths representing an overall mortality of 60.9%. Sepsis was the commonest cause of death and accounted for 39.6%, n = 61 of the deaths. Younger age of less than 40 years and increased patients' length of stay in the unit were significantly and positively associated with mortality (P < 0.05). The high mortality rates among patients admitted to ICU reflects numerous challenges at various levels of critical care service delivery in the country. There is therefore a need to strengthen critical care services to improve treatment outcomes for patients admitted to ICU of the facility.

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ObjectiveTo explore doctors’ experiences of referring and admitting patients to the intensive care unit (ICU) at two tertiary hospitals in Malawi.DesignThis was a qualitative study that used face-to-face interviews. The interviews were audiotaped and transcribed verbatim into English. The data were analysed manually through conventional content analysis.SettingTwo public tertiary hospitals in the central and southern regions of Malawi. Interviews were conducted from January to June 2021.ParticipantsSixteen doctors who were involved in the referral and admission of patients to the ICU.ResultsFour themes were identified namely, lack of clear admission criteria, ICU admission requires a complex chain of consultations, shortage of ICU resources, and lack of an ethical and legal framework for discontinuing treatment of critically ill patients who were too sick to benefit from ICU.ConclusionDespite the acute disease burden and increased demand for ICU care, the two hospitals lack clear processes for referring and admitting patients to the ICU. Given the limited bed space in ICUs, hospitals in low-income countries, including Malawi, need to improve or develop admission criteria, severity scoring systems, ongoing professional development activities, and legislation for discontinuing intensive care treatments and end-of-life care.

IntroductionThe coronavirus pandemic overwhelmed the healthcare landscape, placing a strain on healthcare workers worldwide. In addition todirectly causing the deaths of people, the COVID-19 pandemic disrupted critical health services in developing countries. The studyaimed to explore the experiences of healthcare workers who cared for critically ill COVID-19 patients at a tertiary hospital in Malawi.MethodsA qualitative descriptive design was used. Data were gathered through in-depth interviews with doctors, clinical officers, nurses, andallied staff (n=25) who were involved in the care of critically ill COVID-19 patients at the hospital’s COVID-19 treatment centres duringthe first and second waves of the pandemic in Malawi. The interviews were conducted in English, audiotaped, and later transcribedverbatim. Conventional content analysis was used to analyse the data following the steps proposed by Hsieh and Shannon1.ResultsThe overall experience of the health workers was negative. However, delivering care to critically ill COVID-19 patients was associatedwith positive and negative experiences. The positive experience was a result of teamwork among staff and support from hospital authoritiesand the community. Negative experiences, on the other hand, were attributed to a lack of knowledge and skills in managing critically illCOVID-19 patients, a lack of resources, and abuse by some patients and members of the community. Furthermore, there was fear ofcontracting the virus from patients and fellow health workers while providing care.ConclusionThe findings point to the need for adequate preparedness within the health sector to support and protect the healthcare workers andindividuals they look after. There is a need for disease awareness strategies for health workers and the general public for future pandemics.