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The African Critical Illness Outcomes Study (ACIOS): A Point Prevalence Study of Critical Illness in 22 Nations in Africa

68 Pages Posted: 30 Sep 2024

See all articles by Tim Baker

Tim Baker

Muhimbili University of Health and Allied Sciences

Juan Scribante

School of Clinical Medicine. Faculty of Health Sciences, University of the Witwatersrand

Muhammed Elhadi

Faculty of Medicine, University of Tripoli

Adesoji O. Ademuyiwa

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital

Babatunde Osinaike

University of Ibadan - Department of Anaesthesia

Christian Owoo

University of Ghana Medical School

Daniel Sottie

Korle Bu Teaching Hospital

Karima Khalid

Muhimbili University of Health and Allied Sciences

Adam Hewitt-Smith

Busitema University

Arthur Kwizera

Makerere University - Department of Anaesthesia and Critical Care

Fitsum Kifle

Debre Berhan University

Degsew Dersso Mengistu

Ministry of Health (Ethiopia)

Yared Boru Firissa

Aksum University - Comprehensive Specialized Hospital

Tirunesh Busha Gemechu

Addis Ababa University - Black Lion Hospital

Gaudencia Dausab

Ministry of Health and Social Services

Unotjari Kauta

Ministry of Health and Social Services

Kaveto Sikuvi

University of Namibia

Nahla Kechiche

University of Monastir - University Hospital of Monastir

Kélan Bertille Ki

Université de Ouagadougou - Centre hospitalier universitaire pédiatrique Charles de Gaulle

Martin Mukenga

Université de Kinshasa - Kinshasa University Hospital

Dolly Matondo Munlemvo

Université de Kinshasa - Kinshasa University Hospital

Mustapha Bittaye

Ministry of Health and Social Welfare, The Gambia

Abubacarr Jagne

University of The Gambia

Mohamed Abdinor Omar

Ministry of Health Somalia

Hassan Ali Daoud

Amoud University

Mohamed Faisal

University of Hargeisa

Mahmoud Elfiky

Kasr Al Ainy Faculty of Medicine, Cairo University

Mpho Seleke

Ministry of Health, Lesotho

Tarig Fadalla

National Ribat University

Alshaima Koko

National Ribat University

Alemayehu Bedada

University of Botswana

Gilles Niengo Outsouta

Marien Ngouabi University

Marie Elombila

Marien Ngouabi University

Ahmed Rhassane El Adib

Cadi Ayyad University - University Hospital Center Mohamed VI

Meryem Essafti

University Hospital of Mohammed VI

Dino Lopes

Eduardo Mondlane University (UEM) - Maputo Central Hospital

Atilio Morais

Universidade Eduardo Mondlane

Pisirai Ndarukwa

Bindura University of Science Education

Newten Handireketi

Bindura University of Science Education

Fred Bulamba

Busitema University

Busisiwe Mrara

Walter Sisulu University

Hyla Kluyts

Department of Anaesthesiology, Sefako Makgatho Health Sciences University

Marian Kinnes

University of Cape Town (UCT)

Gillian J. Bedwell

University of Cape Town (UCT)

Hanel Duvenage

Nutrition, Research and Development Manager, Safe Surgery South Africa

Gwendoline Arendse

University of Cape Town (UCT)

Luke Hannan

University of Cape Town (UCT)

Landon Myer

University of Cape Town (UCT) - Division of Epidemiology & Biostatistics

Anneli Hardy

University of Cape Town (UCT) - Department of Statistical Sciences

Carl Otto Schell

Uppsala University

Rupert M. Pearse

Queen Mary University of London - Critical Care and Perioperative Medicine Research Group

Bruce Biccard

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine

Members of the African Critical Illness Outcomes Study (ACIOS) Investigators

Independent

More...

Abstract

Background: Critical illness represents a major global healthcare burden and critical care is an essential component of hospital care. There are few data describing the prevalence, treatment and outcomes of critically ill patients in African hospitals.

Methods: International prospective point-prevalence study in acute hospitals across Africa. Investigators examined all in-patients ≥18 years, regardless of location, to assess the co-primary outcomes of critical illness and seven-day mortality. Patients were classified as critically ill if ≥1 vital signs were severely deranged. Data were collected describing available resources and care provided to patients. Data are presented as mean (SD), median (IQR), n (%) and odds ratios (OR) with 95% confidence intervals.

Findings: We included 19872 patients from 180 hospitals in 22 African countries between September and December 2023. The median age was 40 (29-59) years, and 11078/19862 (55·8%) patients were women. There were 967/19780 (4·9%) deaths. On census day, 2461/19743 (12·5%) patients were critically ill, with 1688/2459 (68·6%) cared for in general wards. Among the critically ill, 507/2450 (20·7%) patients died in hospital. Mortality for non-critically ill patients was 458/17205 (2·7%). Critical illness on census day was independently associated with subsequent in-hospital mortality (adjusted OR 7·59 [6·50-8·79]). Of the critically ill patients with respiratory failure, 557/1151 (48·4%) were receiving oxygen, of those with circulatory failure 521/965 (54·0%) were receiving intravenous fluids or vasopressors and of those with low conscious level, 387/784 (49·4%) were receiving an airway intervention or placed in the recovery position.

Interpretation: One in eight patients in hospitals in Africa are critically ill, of whom one in five dies within seven days. Most critically ill patients are cared for in general wards, and most do not receive the essential emergency and critical care treatments they require. Our findings suggest a high incidence of preventable deaths due to critical illness in Africa.

Funding: The study was funded by the National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850).

Declaration of Interest: RP has received research grants and honoraria from Edwards Lifesciences. All other authors declare that they have no conflict of interest.

Ethical Approval: The primary ethics approval was provided by the Human Research Ethics Committee of the University of Cape Town, South Africa (HREC 260/2023).

Keywords: Critical Care, Critical Illness, Emergency Medicine, Africa, Global Health, Health Services, Vital Signs, Epidemiology, Mortality

Suggested Citation

Baker, Tim and Scribante, Juan and Elhadi, Muhammed and Ademuyiwa, Adesoji O. and Osinaike, Babatunde and Owoo, Christian and Sottie, Daniel and Khalid, Karima and Hewitt-Smith, Adam and Kwizera, Arthur and Kifle, Fitsum and Mengistu, Degsew Dersso and Firissa, Yared Boru and Gemechu, Tirunesh Busha and Dausab, Gaudencia and Kauta, Unotjari and Sikuvi, Kaveto and Kechiche, Nahla and Ki, Kélan Bertille and Mukenga, Martin and Munlemvo, Dolly Matondo and Bittaye, Mustapha and Jagne, Abubacarr and Omar, Mohamed Abdinor and Ali Daoud, Hassan and Faisal, Mohamed and Elfiky, Mahmoud and Seleke, Mpho and Fadalla, Tarig and Koko, Alshaima and Bedada, Alemayehu and Outsouta, Gilles Niengo and Elombila, Marie and El Adib, Ahmed Rhassane and Essafti, Meryem and Lopes, Dino and Morais, Atilio and Ndarukwa, Pisirai and Handireketi, Newten and Bulamba, Fred and Mrara, Busisiwe and Kluyts, Hyla and Kinnes, Marian and Bedwell, Gillian J. and Duvenage, Hanel and Arendse, Gwendoline and Hannan, Luke and Myer, Landon and Hardy, Anneli and Schell, Carl Otto and Pearse, Rupert M. and Biccard, Bruce and Investigators, Members of the African Critical Illness Outcomes Study (ACIOS), The African Critical Illness Outcomes Study (ACIOS): A Point Prevalence Study of Critical Illness in 22 Nations in Africa. Available at SSRN: https://ssrn.com/abstract=4955306

Tim Baker (Contact Author)

Muhimbili University of Health and Allied Sciences ( email )

UPANGA WEST
DAR ES SALAAM
Tanzania

Juan Scribante

School of Clinical Medicine. Faculty of Health Sciences, University of the Witwatersrand ( email )

Muhammed Elhadi

Faculty of Medicine, University of Tripoli ( email )

Adesoji O. Ademuyiwa

Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital ( email )

Babatunde Osinaike

University of Ibadan - Department of Anaesthesia ( email )

Christian Owoo

University of Ghana Medical School ( email )

Accra
Ghana

Daniel Sottie

Korle Bu Teaching Hospital ( email )

Ghana

Karima Khalid

Muhimbili University of Health and Allied Sciences ( email )

UPANGA WEST
DAR ES SALAAM
Tanzania

Adam Hewitt-Smith

Busitema University ( email )

P.O Box 236
Tororo, 236
Uganda

Arthur Kwizera

Makerere University - Department of Anaesthesia and Critical Care ( email )

United States

Fitsum Kifle

Debre Berhan University ( email )

Degsew Dersso Mengistu

Ministry of Health (Ethiopia) ( email )

Yared Boru Firissa

Aksum University - Comprehensive Specialized Hospital ( email )

Tirunesh Busha Gemechu

Addis Ababa University - Black Lion Hospital ( email )

Addis Ababa
Ethiopia

Gaudencia Dausab

Ministry of Health and Social Services ( email )

Unotjari Kauta

Ministry of Health and Social Services ( email )

Kaveto Sikuvi

University of Namibia ( email )

Nahla Kechiche

University of Monastir - University Hospital of Monastir ( email )

Kélan Bertille Ki

Université de Ouagadougou - Centre hospitalier universitaire pédiatrique Charles de Gaulle ( email )

Martin Mukenga

Université de Kinshasa - Kinshasa University Hospital ( email )

Dolly Matondo Munlemvo

Université de Kinshasa - Kinshasa University Hospital ( email )

Mustapha Bittaye

Ministry of Health and Social Welfare, The Gambia ( email )

Abubacarr Jagne

University of The Gambia ( email )

Mohamed Abdinor Omar

Ministry of Health Somalia ( email )

Hassan Ali Daoud

Amoud University ( email )

Mohamed Faisal

University of Hargeisa ( email )

DHL Somaliland
Hargeisa
Somalia

Mahmoud Elfiky

Kasr Al Ainy Faculty of Medicine, Cairo University ( email )

Kasr Al Ainy Faculty of Medicine
Manial
Cairo, 11432
Egypt

Mpho Seleke

Ministry of Health, Lesotho ( email )

Tarig Fadalla

National Ribat University ( email )

Alshaima Koko

National Ribat University ( email )

Alemayehu Bedada

University of Botswana ( email )

Private Bag 00702
4775 Notwane Rd
Gaborone
Botswana

Gilles Niengo Outsouta

Marien Ngouabi University ( email )

Marie Elombila

Marien Ngouabi University ( email )

Ahmed Rhassane El Adib

Cadi Ayyad University - University Hospital Center Mohamed VI ( email )

Meryem Essafti

University Hospital of Mohammed VI ( email )

Dino Lopes

Eduardo Mondlane University (UEM) - Maputo Central Hospital ( email )

Mozambique

Atilio Morais

Universidade Eduardo Mondlane ( email )

Maputo
Mozambique

Pisirai Ndarukwa

Bindura University of Science Education ( email )

Bindura
Zimbabwe

Newten Handireketi

Bindura University of Science Education ( email )

Fred Bulamba

Busitema University ( email )

P.O Box 236
Tororo, 236
Uganda

Busisiwe Mrara

Walter Sisulu University ( email )

South Africa

Hyla Kluyts

Department of Anaesthesiology, Sefako Makgatho Health Sciences University ( email )

Marian Kinnes

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Gillian J. Bedwell

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Hanel Duvenage

Nutrition, Research and Development Manager, Safe Surgery South Africa ( email )

Gwendoline Arendse

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Luke Hannan

University of Cape Town (UCT) ( email )

Cape Town
South Africa

Landon Myer

University of Cape Town (UCT) - Division of Epidemiology & Biostatistics ( email )

Anneli Hardy

University of Cape Town (UCT) - Department of Statistical Sciences ( email )

Carl Otto Schell

Uppsala University ( email )

Rupert M. Pearse

Queen Mary University of London - Critical Care and Perioperative Medicine Research Group ( email )

London
United Kingdom

Bruce Biccard

University of Cape Town (UCT) - Department of Anaesthesia and Perioperative Medicine ( email )

Cape Town
South Africa