A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients

Wachira, Benjamin; Mwai, Margarita

doi:10.1016/j.afjem.2021.01.001

Cited by 8 publications

(11 citation statements)

References 19 publications

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Section: Discussionmentioning

confidence: 99%

“…It is also pertinent to note the gaps in IPC; only 14% ICUs had a designated room for isolation, similar to 16% reported in Kenya, yet access to PPE was higher at 71% compared to 52% to 59% for gowns and masks in Kenya. 22 Comparison of ICUs across countries or regions is hampered by the lack of generalizable definitions. 13 This study adopted the 2017 WFSICCM consensus definitions and criteria for categorizing ICUs.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

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Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia

Kifle

Boru

Tamiru

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: The burden of critical illness in low-income countries is high and expected to rise. This has implications for wider public health measures including maternal mortality, deaths from communicable diseases, and the global burden of disease related to injury. There is a paucity of data pertaining to the provision of critical care in low-income countries. This study provides a review of critical care services in Ethiopia. METHODS: Multicenter structured onsite surveys incorporating face-to-face interviews, narrative discussions, and on-site assessment were conducted at intensive care units (ICUs) in September 2020 to ascertain structure, organization, workforce, resources, and service capacity. The 12 recommended variables and classification criteria of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) taskforce criteria were utilized to provide an overview of service and service classification. RESULTS: A total of 51 of 53 (96%) ICUs were included, representing 324 beds, for a population of 114 million; this corresponds to approximately 0.3 public ICU beds per 100,000 population. Services were concentrated in the capital Addis Ababa with 25% of bed capacity and 51% of critical care physicians. No ICU had piped oxygen. Only 33% (106) beds had all of the 3 basic recommended noninvasive monitoring devices (sphygmomanometer, pulse oximetry, and electrocardiography). There was limited capacity for ventilation (n = 189; 58%), invasive monitoring (n = 9; 3%), and renal dialysis (n = 4; 8%). Infection prevention and control strategies were lacking. CONCLUSIONS: This study highlights major deficiencies in quantity, distribution, organization, and provision of intensive care in Ethiopia. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority.

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Section: Discussionmentioning

confidence: 99%

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia

Kifle

Boru

Tamiru

et al. 2021

Anesthesia &Amp; Analgesia

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“…Our study is the first to be conducted in sub-Saharan Africa. In Kenya, a population of over 47 million has access to a total of only 12 radiation therapy units across 47 counties [22][23][24]. Our primary objective was to assess the feasibility to safely administer LDRT within a tertiary care university center at a time when majority of the in-patient beds were occupied by patients with severe COVID-19 pneumonia.…”

Section: Plos Onementioning

confidence: 99%

A pilot phase Ib/II study of whole-lung low dose radiation therapy (LDRT) for the treatment of severe COVID-19 pneumonia: First experience from Africa

et al. 2022

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Background Low dose radiation therapy (LDRT) has been used for non-malignant conditions since early 1900s based on the ability of single fractions between 50–150 cGy to inhibit cellular proliferation. Given scarcity of resources, poor access to vaccines and medical therapies within low and middle income countries, there is an urgent need to identify other cost-effective alternatives in management of COVID-19 pneumonia. We conducted a pilot phase Ib/II investigator-initiated clinical trial to assess the safety, feasibility, and toxicity of LDRT in patients with severe COVID-19 pneumonia at the Aga Khan University Hospital in Nairobi, Kenya. Additionally, we also assessed clinical benefit in terms of improvement in oxygenation at day 3 following LDRT and the ability to avoid mechanical ventilation at day 7 post LDRT. Methods Patients with both polymerase chain reaction (PCR) and high-resolution computer tomogram (HRCT) confirmed severe COVID-19 pneumonia, not improving on conventional therapy including Dexamethasone and with increasing oxygen requirement were enrolled in the study. Patients on mechanical ventilation were excluded. Eligible patients received a single 100cGy fraction to the whole lung. In the absence of any dose limiting toxicity the study proposed to treat a total of 10 patients. The primary endpoints were to assess the safety/feasibility, and toxicity within the first 24 hours post LDRT. The secondary endpoints were to assess efficacy of LDRT at Day 3, 7, 14 and 28 post LDRT. Results Ten patients were treated with LDRT. All (100%) of patients were able to complete LDRT without treatment related SAE within the first 24 hours post treatment. None of the patients treated with LDRT experienced any acute toxicity as defined by change in clinical and respiratory status at 24hr following LDRT. Majority (90%) of patients avoided mechanical ventilation within 7 days of LDRT. Four patients (40%) demonstrated at least 25% improvement in oxygen requirements within 3 days. Six patients (60%) were discharged and remained off oxygen, whereas four progressed and died (1 due to sepsis and 3 in cytokine storm). Median time to discharge (n = 6) was 16.5 days and median time to death (n = 4) was 11.0 days. Patients who ultimately died showed elevated inflammatory markers including Ferritin, CRP and D-dimers as compared to those who were discharged alive. Conclusion LDRT was feasible, safe and shows promise in the management of severe COVID-19 pneumonia including in patients progressing on conventional systemic treatment. Additional phase II trials are warranted to identify patients most likely to benefit from LDRT.

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“…Kenya, also in East Africa and a lower-middle income country, has a population of 53 million [ 23 ]. A recent survey found that oxygen therapy was only available in 78% of facilities, that there were 537 ICU beds and, as with Tanzania, varied availability of the resources required for delivery of effective critical illness care [ 26 ]. The limited availability of critical illness care in these settings suggests that both countries should consider the introduction of EECC.…”

Section: Introductionmentioning

confidence: 99%

Essential emergency and critical care as a health system response to critical illness and the COVID19 pandemic: what does it cost?

Guinness

Kairu

Kuwawenaruwa

et al. 2023

Cost Eff Resour Alloc

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Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020.The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively.EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited. Graphical Abstract

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A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients

Cited by 8 publications

References 19 publications

Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia

Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia

A pilot phase Ib/II study of whole-lung low dose radiation therapy (LDRT) for the treatment of severe COVID-19 pneumonia: First experience from Africa

Essential emergency and critical care as a health system response to critical illness and the COVID19 pandemic: what does it cost?

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