National intensive care unit bed capacity and ICU patient characteristics in a low income country

Abstract

BackgroundPrimary health care delivery in the developing world faces many challenges. Priority setting favours HIV, TB and malaria interventions. Little is known about the challenges faced in this setting with regard to critical care medicine. The aim of this study was to analyse and categorise the diagnosis and outcomes of 1,774 patients admitted to a hospital intensive care unit (ICU) in a low-income country over a 7-year period. We also assessed the country’s ICU bed capacity and described the challenges faced in dealing with critically ill patients in this setting.FindingsA retrospective audit was conducted in a general ICU in a university hospital in Uganda. Demographic data, admission diagnosis, and ICU length of stay were recorded for the 1,774 patients who presented to the ICU in the period January 2003 to December 2009. Their mean age was 35.5 years. Males accounted for 56.5% of the study population; 92.8% were indigenous, and 42.9% were referrals from upcountry units. The average mortality rate over the study period was 40.1% (n = 715). The highest mortality rate (44%) was recorded in 2004 and the lowest (33.2%) in 2005. Children accounted for 11.6% of admissions (40.1% mortality). Sepsis, ARDS, traumatic brain injuries and HIV related conditions were the most frequent admission diagnoses. A telephonic survey determined that there are 33 adult ICU beds in the whole country.ConclusionsMortality was 40.1%, with sepsis, head injury, acute lung injury and HIV/AIDS the most common admission diagnoses. The country has a very low ICU bed capacity. Prioritising infectious diseases poses a challenge to ensuring that critical care is an essential part of the health care package in Uganda.

The International Epidemiology of Acute Respiratory Distress Syndrome

“…The relative effect of positive end-expiratory pressure on syndrome definition may be moot at a hospital in Mulago, Uganda, where a 12-bed ICU can only provide six patients with mechanical ventilation in a 1,500 bed national-referral hospital and public university teaching hospital (10). In fact, in the entirety of Uganda, only 33 adult ICU beds are capable of providing mechanical ventilation (10,11). Extrapolating studies and treatments may be difficult across borders.…”

“…Rural regions of low-income countries are associated with higher rates of poverty and poor health status that must overcome obstacles of meager road conditions and inadequate communication services to reach an appropriate health facility (9). The relative effect of positive end-expiratory pressure on syndrome definition may be moot at a hospital in Mulago, Uganda, where a 12-bed ICU can only provide six patients with mechanical ventilation in a 1,500 bed national-referral hospital and public university teaching hospital (10). In fact, in the entirety of Uganda, only 33 adult ICU beds are capable of providing mechanical ventilation (10,11).…”

“…In resource-poor, low-income countries, erratic power and water supplies pose an additional challenge for ventilatory support (16). Aside from varying risk factors and available resources, access to an ICU in a timely fashion impacts mortality (10). Not surprisingly, it would be challenging to analyze the predictive ability of ARDS from Eastern to Western Europe, let alone across all World Health Organization (WHO) regions.…”

Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa

“…Uganda, for instance, has 0.1 ICU beds per 100,000 people as compared to 20 per 100,000 in the USA (Jochberger et al, 2008;Kwizera, Dünser, & Nakibuuka, 2012). Kenya has 37 critical care beds in public hospitals and 57 in fee-paying private facilities for a population of 40 million (Misango, 2012).…”

Reducing the global burden of sepsis

“…3 An estimated 30 million cases of sepsis each year result in more than 8 million deaths. This number is likely an underestimate, however, because data on incidence and outcomes are often poorly captured in low-and middleincome countries where access to care is difficult.…”