An assessment of critical care capacity in the Gambia

Touray, Sunkaru; Sanyang, Baboucarr; Zandrow, Gregory; Dibba, Fatoumatta; Fadera, Kaddy; Kanteh, Ebrima; Danso, Madikoi; Sanyang, Landing N; Njie, Masirending; Johnson, Grey; Sanyang, Awa; Touray, Awa

doi:10.1016/j.jcrc.2018.07.022

Cited by 27 publications

(29 citation statements)

References 42 publications

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“…Critical care beds therefore constitute only 0.55% of the 90 acute care beds per 100,000 people in Ghana [ 22 ]. The reported number of critical care beds adjusted for population in Ghana is similar to other sub-Saharan African countries such as Uganda (0.1 ICU beds/100,000) [ 9 , 23 ], Kenya (0.29 ICU beds/100,000) [ 8 ], The Gambia (0.4 ICU beds/100,000) [ 5 ] and Zambia (0.6 ICU beds/100,000) [ 24 ].…”

Section: Discussionsupporting

confidence: 52%

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Capacity of intensive care units in Ghana

Siaw-Frimpong

Touray

Sefa

2021

Journal of Critical Care

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Purpose To document the equipment, resource and bed capacity of Intensive Care Units (ICUs) in the Republic of Ghana. Materials and methods Cross-sectional observational study of all operating ICUs in Ghana. Sixteen operating ICUs in 9 hospitals were identified and surveyed (13 adult and 3 pediatric ICUs). Results There were a total of 113 adult and 36 pediatric ICU beds for a population of 30 million, (0.5 ICU beds per 100,000 people). The median number of staffed ICU beds and ventilators were 5 (IQR 4–6), and 4 (IQR 3–5) respectively. There were 2 pediatric and 6 adult intensivists practicing in the country. About half of the ICUs (56%) were staffed solely by non-intensivist providers. While there is adequate nursing support and availability of essential critical care medications, the current financing model for critical care delivery creates a significant barrier for most patients. Conclusion Ghana has a significant shortage of critical care beds that are inequitably distributed across the country and a shortfall of intensivists to staff ICUs. A holistic approach that focuses on the key bottlenecks to quality improvement would be required to improve the capacity and quality of critical care delivery.

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Section: Discussionsupporting

confidence: 52%

“…The existing critical care capacity of many African countries is unknown because it is a relatively new and underdeveloped specialty. Furthermore, the extent and impact of the gap in critical care is reported by only a few African countries [ [5] , [6] , [7] , [8] , [9] ].…”

Section: Introductionmentioning

confidence: 99%

Capacity of intensive care units in Ghana

Siaw-Frimpong

Touray

Sefa

2021

Journal of Critical Care

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“…In Africa, ICU beds and personnel trained in critical care are limited to tertiary hospitals, as assessed in the Republic of The Gambia; therefore, mortality associated with COVID-19 is likely to exceed the reported case fatality rate of 2.3%. 7 Furthermore, it is debatable whether low-and middle-income countries (LMICs) can fund the additional cost of critical care units from their limited health budgets.…”

Section: Critical Carementioning

confidence: 99%

Managing COVID-19 in Low- and Middle-Income Countries

Hopman

Allegranzi

Mehtar

2020

JAMA

498

470

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The public health response to coronavirus disease 2019 in China has illustrated that it is possible to contain COVID-19 if governments focus on tried and tested public health outbreak responses. 1,2 Isolation, quarantine, social distancing, and community containment measures were rapidly implemented. In China, patients with COVID-19 were immediately isolated in designated existing hospitals, and new hospitals were rapidly built to manage the increasing numbers of cases in the most affected areas. Home quarantine for contacts was initiated and large gatherings were canceled. Additionally, community containment for approximately 40 million to 60 million residents was instituted. A significant positive association between the incidence of COVID-19 cases and mortality was apparent in the Chinese response. 3 That is, the rapid escalation in the number of infections in China had resulted in insufficient health care resources, followed by an increase in mortality.The association of mortality with health care resources should provide guidance for resource-limited regions on how and when to prepare for possible local outbreaks. 3 In addition, lessons learned from the 2003 severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak geared toward strengthening of public health systems will be helpful. COVID-19 Preparedness in AfricaLeaders have 2 important responsibilities in times of crisis: to solve the immediate problem and keep it from happening again. 4 An African task force for coronavirus preparedness and response (AFTCOR) has been established,

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“…Most focused primarily on the availability of hardware or infrastructure rather than functional aspects of emergency care 10. Some researchers have tried to measure performance of EM practice in resource-limited settings, which has resulted in a demand for a comprehensive EM assessment tool for LMICs 11,12,13. Recently, a novel approach based on work in the field of obstetrics, called sentinel condition and signal function, was adapted for EM by the African Federation for Emergency Medicine (AFEM) 14, 15…”

Section: Introductionmentioning

confidence: 99%

Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Seo

Kim

et al. 2019

WestJEM

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Low-and middle-income countries (LMICs) have a large percentage of global mortality and morbidity rates from non-communicable diseases, including trauma. The establishment and development of emergency care systems is crucial for addressing this problem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICs is essential for proper design and operation of ECS (emergency care services) reinforcement programs. Myanmar has particular challenges with road access for providing timely emergency medical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar, we used the Emergency Care Assessment Tool (ECAT), which features newly developed tools for assessing sentinel conditions and signal functions (key interventions to address morbidity and mortality) in emergency care facilities. Methods: ECAT is composed of six emergent sentinel conditions and corresponding signal functions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed survey sheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarify ambiguous answers. Results:We categorized the nine participating institutions according to predefined criteria: four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basic hospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of the intermediate hospitals showed weakness in trauma care, as well as critical care such as shock management. Only half had a separate triage area for patients. In contrast, all signal functions and resources listed in ECAT were available in the advanced-level hospital. Conclusion:Basic-level facilities in Myanmar were shown to be suboptimal in trauma management, with critical care also inadequate in intermediate facilities. To reinforce signal functions in Myanmar health facilities, stakeholders should consider expanding critical functions in selected lower-level health facilities. A larger scale survey would provide more comprehensive data to improve emergency care in Myanmar. [

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An assessment of critical care capacity in the Gambia

Cited by 27 publications

References 42 publications

Capacity of intensive care units in Ghana

Capacity of intensive care units in Ghana

Managing COVID-19 in Low- and Middle-Income Countries

Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

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