Intensive care medicine in rural sub‐Saharan Africa

Abstract

Summary We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients admitted to the intensive care unit. The most frequent admission diagnoses were postoperative state (including following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%). Intensive care unit mortality was 27.8%, differing between age groups (p < 0.001). Intensive care unit mortality was highest for neonatal tetanus (29/37; 78.4%) and lowest for foreign body aspiration (4/204; 2.0%). Intensive care unit admission following surgery (333/1431; 23.3%), medical conditions (327/1431; 22.9%) and traumatic brain injury (233/1431; 16.3%) caused the highest number of deaths. Of all deaths in the hospital, (1431/11,357; 12.6%) occurred in the intensive care unit. Although the proportion of hospitalised patients admitted to the intensive care unit increased over time, from 0.7% in 2005/6 to 2.8% in 2013/4 (p < 0.001), overall hospital mortality decreased (2005/6, 4.8%; 2013/14, 4.0%; p < 0.001). The proportion of intensive care patients whose lungs were mechanically ventilated was 18.7% (961/5147). This subgroup of patients did not change over time (2006, 16%; 2015, 18.4%; p = 0.12), but their mortality decreased (2006, 59.5%; 2015, 44.3%; p < 0.001).

The analgesic effects of intrathecal morphine in comparison with ultrasound‐guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital

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Factors affecting mortality after traumatic brain injury in a resource-poor setting

“…It is limited in its capability for neurosurgical care, with no CT available, and death from TBI remains high, second only to sepsis as the overall cause of death in the hospital in 2017. A 2017 study of all admissions to the ICU in St Mary's Hospital found the mortality rate amongst patients with severe TBI to be 16·3 per cent, but the causes were not explored.…”

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Self‐harm and poisoning data in rural Ugandan hospitals

“…I congratulate Dunser et al. for gathering such a valuable dataset from a rural Ugandan hospital . Such epidemiological data is vital in trying to improve the care of critically ill patients in low to middle‐income countries.…”