Building Critical Care Capacity in a Low-Income Country

Kwizera, Arthur; Sendagire, Cornelius; Kamuntu, Yewande; Rutayisire, Meddy; Nakibuuka, Jane; Muwanguzi, Patience A.; Alenyo-Ngabirano, Anne; Bosa, Henry Kyobe; Olaro, Charles

doi:10.1016/j.ccc.2022.07.003

Cited by 11 publications

(15 citation statements)

References 21 publications

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“…30 Data on HIV were obtained from The Joint United Nations Programme on HIV/AIDS (UNAIDS) and TB from the WHO and Ministry of Health Uganda reports. 31 , 32 Data on chronic obstructive pulmonary disease (COPD) 25 and asthma, 20 , 21 , 33 ICU beds 26 , 34 were obtained from locally published studies. Data on cancers were obtained from Globocan.…”

Section: Methodsmentioning

confidence: 99%

“…Also, several high-quality local data have been published on other important risk factors for fungal diseases including asthma 20 – 24 and chronic obstructive pulmonary disease (COPD) 25 and the population size has changed significantly. Furthermore, intensive care unit (ICU) services and beds have expanded across the country, 26 HIV treatment outcomes have significantly improved, 27 significantly reducing the number of individuals at risk of major opportunistic infections, and finally the incidence of cancers and associated mortality remains high, 28 , 29 reflecting an understudied high-risk population for severe fungal diseases.…”

Section: Introductionmentioning

confidence: 99%

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Re-estimation of the burden of serious fungal diseases in Uganda

Bongomin,

Kwizera,

Namusobya

et al. 2024

Therapeutic Advances in Infection

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Background: It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective: We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods: Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results: With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion: Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Re-estimation of the burden of serious fungal diseases in Uganda

Bongomin,

Kwizera,

Namusobya

et al. 2024

Therapeutic Advances in Infection

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“…In Uganda, most of the ICUs have few ICU-trained staff, with most facilities being anaesthesiologists-led and the majority of the ICUs had a nurse-to-patient ratio of greater than or equal to 1.2. [ 12 ]…”

Section: Where Are We In Sub-saharan Africa?mentioning

confidence: 99%

Critical care in sub-Saharan Africa, where are we? A review

Tobi,

Ogunbiyi

2023

J West Afr Coll Surg

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Critical care services in sub-Saharan Africa have not gained much grounds despite becoming part of modern clinical practice in the 1950s. Managing patients with potentially recoverable illnesses and injuries is still not at par with evidence-based practices in developed climes, and most die from many preventable causes. Many hospitals in Africa do not have an intensive care unit, leaving critically ill patients being treated mostly in the general wards. A survey from Zambia indicated that only 7% of hospitals in the country have an intensive care unit, whereas a cross-sectional survey in Nigeria revealed that there were 30 public and private intensive care units serving a population of over 200 million, spread around all the geo-political zones, with most in the teaching hospitals. The situation is not generally better in most parts of the continent. This review focuses on why critical care is at the level it is in sub-Saharan Africa and provides suggestions on what should be done to change the narrative.

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“…Additionally, a targeted intervention to improve quality of care focusing on capacity building was developed and implemented by WHO to strengthen knowledge and skill building for ICU staff. A clear focus was placed on ICUs, as they were a cost-heavy and resource-intensive service at the frontlines of the COVID-19 pandemic with a massive increase in the influx of critically ill patients [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing quality of critical care during an ongoing health emergency—a novel approach to evaluate quality of care at Lebanese public ICUs during COVID-19

AbouNader,

Abou Mourad,

Chalouhi

et al. 2024

International Journal for Quality in Health Care

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Background Quality of care has been systematically monitored in hospitals in high-income countries to ensure adequate care. However, in low- and middle-income countries, quality indicators are not readily measured. The primary aim of this study was to assess to what extent it was feasible to monitor the quality of Intensive care in an ongoing health emergency, and the secondary aim was to assess a quality of care intervention (twinning project) focused on Intensive Care Unit (ICU) quality of care in public hospitals in Lebanon. Methods We conducted a retrospective cohort study nested within an intervention implemented by the World Health Organization (WHO) together with partners. To assess the quality of care throughout the project, a monitoring system framed in the Donabedian model and included structure, process, and outcome indicators was developed and implemented. Data collection consisted of a checklist performed by external healthcare workers (HCWs) as well as collection of data from all admitted patients performed by each unit. The association between the number of activities within the interventional project and ICU mortality was evaluated. Results . A total of 1 679 patients were admitted to five COVID-19 ICUs during the study period. The project was conducted fully across 4 out of 5 hospitals. In these hospitals, a significant reduction in ICU mortality was found (OR: 0.83, p<0.05, CI: 0.72–0.96). Conclusion We present a feasible way to assess quality of care in ICUs and how it can be used in assessing a quality improvement project during ongoing crises in resource-limited settings. By implementing a quality of care intervention in Lebanon’s public hospitals, we have shown that such initiatives might contribute to improvement of ICU care. The observed association between increased numbers of project activities and reduced ICU mortality underscores the potential of quality assurance interventions to improve outcomes for critically ill patients in resource-limited settings. Future research is needed to expand this model to be applicable in similar settings.

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Building Critical Care Capacity in a Low-Income Country

Cited by 11 publications

References 21 publications

Re-estimation of the burden of serious fungal diseases in Uganda

Re-estimation of the burden of serious fungal diseases in Uganda

Critical care in sub-Saharan Africa, where are we? A review

Assessing quality of critical care during an ongoing health emergency—a novel approach to evaluate quality of care at Lebanese public ICUs during COVID-19

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