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

Abstract

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.

Maternal and fetal health outcomes of cesarean sections (CS) in Ethiopia: results from retrospective cross-sectional study of Southern Ethiopia Gurage Zone Governmental Hospitals

“…Indicating that, if the mother has more preoperative blood loss and physiological disturbances, the maternal body's tolerance for both intraoperative and postoperative events is reduced, resulting in a worsening of the patient's outcome. Transfusions before surgery and various postoperative interventions may be required for patients with hemoglobin levels below 11 [23] , which these rural institutions may be unable to provide as most lack this capacity-for example, blood transfusions (in the absence of readily available blood), tertiary level critical care, and so on [24,25] .…”

The State of Critical Care Provision in Low-Resource Environments

“…High-income countries have 2 to 5 ICU beds per 100 hospital beds (the United States has even higher—9 ICU beds per 100 hospital beds). 3 Although Kifle et al 1 report between 1 and 6 ICU beds per 100 hospital beds in Addis Ababa, outside the capital, the ratio is <1 ICU bed per 100 hospital beds. Furthermore, high-level-care beds are virtually nonexistent in Ethiopia, and not 1 of the ICUs fulfilled the level 3 ICU criteria.…”

“…13 The data from the Ethiopian survey suggest that there is the potential for important quality improvement initiatives through simple protocols in the critical care environment. 1 A call has been made for simple protocols in critical care to improve critical care outcomes in Africa. 14 This same group subsequently demonstrated that even the presence of a well-resourced ICU in an LMIC is not enough to guarantee good patient outcomes in the absence of protocolized care.…”

Predictors of ICU Mortality among Mechanically Ventilated Patients: An Inception Cohort Study from a Tertiary Care Center in Addis Ababa, Ethiopia

“…They are more likely to be referred to the ICU with advanced illness [ 1 , 9 ]. In addition, ICUs are few and inadequately equipped [ 3 , 5 ]. For example, the Ethiopian nationwide ICU survey revealed a significant shortage of mechanical ventilators, with only 203 ventilators for 114 million people in the public sector [ 3 ].…”

“…In addition, ICUs are few and inadequately equipped [ 3 , 5 ]. For example, the Ethiopian nationwide ICU survey revealed a significant shortage of mechanical ventilators, with only 203 ventilators for 114 million people in the public sector [ 3 ]. This equipment is mostly used, donated, and infrequently maintained [ 4 ].…”