The burden of surgical diseases on critical care services at a tertiary hospital in sub-Saharan Africa

Abstract

In many developing countries including those of sub-Saharan Africa care of the critically ill is poorly developed. We therefore sought to elucidate the characteristics and outcomes of critically ill patients to better define the burden of disease and identify strategies for improving care. We conducted a cross sectional observation study of patients admitted to the intensive care unit at Kamuzu Central Hospital in 2010. Demographic, patient characteristics, clinical specialty and outcome data was collected. There were 234 patients admitted during the study period. Older age and admission from trauma, general surgery or medical services were associated with increased mortality. The lowest mortality was among obstetrical and gynecologic patients. Use of the ventilator and transfusions were not associated with increased mortality. Head injured patients had the highest mortality rate among all diagnoses. Rationing of critical care resources using admitting diagnosis or scoring tools can maximize access to critical care services in resource-limited settings. Furthermore, improvements on critical care services will be central to future efforts at reducing surgical morbidity and mortality and improving outcomes in all critically ill patients.

An Audit of Admissions to Intensive Care Unit at Kamuzu Central Hospital in Malawi

“…The results are due to the fact that in this study most patients were admitted with critical conditions which could not be reversed. As also reported in previous studies [7] high mortalities are a result of weaknesses in scoring of severity of illness in resource-limited countries in the absence appropriate laboratory services which constitute parameters of the scoring systems [8], [9]. Results therefore show that there is a need for a limited resource setting disease severity scoring systems at the facility.…”

“…This may be attributed to general increase the number of admissions at the facility [2]. Contrary to what was reported in a previous audit in 2010, [7] the results show that patients that were below the age of 40 were associated with high mortalities. In addition, increased patients' length of stay in ICU was also associated with high mortality.…”

“…Mortality was noted to be higher than that reported in a previous audit of admissions in 2010 in the same ICU [7]. This may be attributed to general increase the number of admissions at the facility [2].…”

Rural surgery in Guinea Bissau: an experience of Doctors Worldwide Turkey

“…Although, many diseases can be curable and deaths preventable by surgical treatment, surgical diseases have long been considered on an individual basis separate from the global public health issues [14]. This may be due to the fact that surgical diseases are not contagious.…”

Challenges to the Provision of Emergency Services and Critical Care in Resource-Constrained Settings

“…As the region continues to struggle with control of these long-standing global health concerns, the growth in gross domestic product and increasing life expectancies have led to an increase in prevalence of noncommunicable diseases such as hypertension, cardiovascular disease, and diabetes with the proportion of deaths due to noncommunicable disease projected to rise from 59% in 2002 to 69% in 2030 [1,2]. Complications from these diseases and those associated with communicable diseases and sepsis [3,4], maternal health and care of the surgical patient [5,6], and those with traumatic injury [5e7] contribute to the need for appropriate emergency and critical care services.…”