Unmet need of essential treatments for critical illness in Malawi

Abstract

Background Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. Methods We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). Results Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). Conclusion There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.

Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital

“…Future research using the methods described in this study in larger cohorts and from other settings would be useful to inform capacity planning with updated estimates of oxygen need. Additionally, as oxygen is essential in many other conditions such as sepsis, trauma [ 15 , 22 , 44 – 46 ] and notably child pneumonia, a disease killing 800,000 children under 5 each year [ 14 , 47 ], estimates for the oxygen needs for treating these conditions would be beneficial.…”

“…It is the first-line treatment of hypoxemia and has been listed as a World Health Organization (WHO) essential medicine [10]. Oxygen is a limited resource in many hospitals in low income countries [11][12][13][14][15], and during the peaks of the pandemic waves there have been reports of hospitals running out of oxygen in high and middle income countries such as the UK, USA, South Africa, Portugal, Egypt and Brazil [16][17][18][19][20][21][22]. In addition, sudden failures of the oxygen systems requiring emergency transport from other sites may happen to hospitals anywhere in the world.…”

Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review

“…1 11 12 Moreover, most critically ill patients do not need critical care at ICU-level 13 and large unmet needs of even basic lifesaving critical care have been found in low/middle-income countries (LMICs). [14][15][16] With various national and international stakeholders calling for critical care scale-up, 17 it is necessary to understand the resources needed in the provision of critical care and their respective costs. Unfortunately, knowledge on the current availability of resources and the costs of critical care remains sparse.…”

“…This makes it difficult for low resource settings to acquire such equipment to meet the needs of their populations and has led to recommendations for the development of more affordable critical care models that can be provided in any hospital settings and to all critically ill patients 1 11 12. Moreover, most critically ill patients do not need critical care at ICU-level13 and large unmet needs of even basic lifesaving critical care have been found in low/middle-income countries (LMICs) 14–16. With various national and international stakeholders calling for critical care scale-up,17 it is necessary to understand the resources needed in the provision of critical care and their respective costs.…”

Oxygen as an Essential Medicine

“…In a similar cross-sectional point prevalence study of adult inpatients admitted to two hospitals in Malawi, 4% of patients had hypoxemia, yet 89% of them were not receiving oxygen therapy. 48 ARDS, an inflammatory form of AHRF, is also highly prevalent in LMICs. In a study of inpatient admissions to one hospital in Rwanda over a 6 week period, 4% of adults met criteria for ARDS using the Kigali modification of the Berlin criteria.…”