An evaluation of inpatient morbidity and critical care provision in Zambia

Abstract

Summary The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48‐h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One‐hundred and twenty medical and surgical admissions were studied. Fifty‐four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines. A greater than expected HIV rate was also noted; 53 of 75 tested patients (71%). When applied to the estimated 17,496 annual acute admissions, this would equate to 7873 patients requiring critical care input annually at this hospital alone. In contrast to this demand, we identified 109 critical care beds nationally, and only eight at this institution.

The effective introduction of Lifebox pulse oximetry to Malawi

“…Implementation of the checklist in sub-saharan Africa has been found to be a challenge, as described by Lilaonitkul et al [11], although the high acuity of patients presenting for surgery in this part of the world [12] means that the opportunity for significant potential benefit in decreased morbidity and mortality by checklist and oximetry use is evident. In the article by Albert et al [6], a 'preventable anaesthesia mortality' in Malawi of approximately 1 in 500 is described, which is orders of magnitude higher than those published for high income countries, which are typically 1 in 50,000 or lower (the 'preventability' at this extreme is of course an ongoing discussion) [13].…”

Global Capnography Project (GCAP): implementation of capnography in Malawi – an international anaesthesia quality improvement project

“…Capnography is also seen as an essential monitor in high‐income countries , and the 4th National Audit Project (NAP4) on major complications of airway management further confirmed the importance of capnography both in the operating theatre and especially in the intensive care unit (ICU) . In low‐income countries, anaesthesia providers routinely work without capnography and there is often a 100% gap between the need for capnography and its availability. This ‘capnography gap’ is defined as the difference between the observed and expected numbers of capnographs in the operating theatre or in the ICU.…”

Four early warning scores predict mortality in emergency surgical patients at University Teaching Hospital, Lusaka: a prospective observational study

“…In the same institution, Dart et al identified that when including medical inpatients, 45% of admissions to UTH had a NEWS score of more than 7. 12 This would suggest that a larger implementation of an EWS system would have an even larger impact on critical care services, which would need to be considered. We suggest that if an EWS such as NEWS was to be introduced in Zambia, it would be necessary in the short term to pick a cut-off for escalation of care that had a high specificity at the expense of sensitivity, to be workable within current resources.…”

“…Previous work done in Zambia by our group has identified that if the NEWS score was used, 45% of acute medical and surgical admissions would have a NEWS score of [ 7, commonly used in the UK as the cut-off for a critical care referral. 12 An accompanying editorial highlighted that NEWS does not consider diagnoses of HIV or TB. 13 The authors suggested that in this population, in addition to physiologic abnormality, HIV and TB are likely to be independent predictors of mortality.…”