In many parts of Africa, critically ill patients are not receiving the life-saving care they desperately need. While intensive care units (ICUs) are standard in high-income countries, such facilities are often scarce in African hospitals. As a result, critically ill patients are frequently treated in general wards, where essential emergency and critical care are often limited or completely unavailable.
Critical illness can arise from various life-threatening conditions, including infections, injuries, or non-communicable diseases such as heart attacks and strokes. The failure of vital organs like the heart, lungs, or brain places the patient at significant risk. In resource-rich settings, intensive care units provide the necessary continuous monitoring, oxygen support, blood pressure stabilizing treatments, and other interventions required to treat these life-threatening conditions. However, in Africa, many hospitals lack the necessary infrastructure, equipment, and trained personnel to provide such care.
Until recently, data on critical illness and care in African hospitals came from small-scale studies, providing only limited insight into the scale of the problem. For instance, a study conducted in Uganda found that 11.7% of inpatients were critically ill, with a 22.6% chance of dying within a week of admission. While these findings were alarming, there was no large-scale research to understand how widespread these issues were across the continent.
This gap in knowledge led to the African Critical Illness Outcomes Study, a collaborative research effort involving clinicians, researchers, and policymakers from across Africa. The study, published in The Lancet, marks the first large-scale examination of critical illness and care across the continent. The study focused on 20,000 patients across 180 hospitals in 22 African countries, spanning from Tunisia in the north to South Africa in the south, and from Ghana in the west to Tanzania in the east.
The findings were startling: 12.5% of hospital inpatients were critically ill, with over two-thirds of these patients being treated in general hospital wards instead of ICUs. The most alarming statistic was that one in five of these critically ill patients died within a week. In addition, the study revealed that more than half of critically ill patients did not receive the basic interventions that could have saved their lives.
The study highlighted significant gaps in the provision of essential life-saving care. Only 48% of patients with respiratory failure received oxygen therapy, while just 54% of patients with circulatory failure (such as shock) received fluids or medications to stabilize their blood pressure. Furthermore, less than half of patients with a dangerously low level of consciousness received basic interventions like airway protection or positioning in the recovery position.
These findings underscore a critical issue facing African healthcare systems: a lack of access to essential emergency and critical care, which could prevent many deaths. The study suggests that thousands of lives could be saved if hospitals were equipped with the necessary resources to provide basic, low-cost life-saving interventions. These interventions include ensuring the availability of oxygen for patients with breathing difficulties, providing fluids or medications to stabilize blood pressure, and training healthcare workers in basic life-support techniques to manage unconscious patients.
Unlike the high-tech treatments often associated with ICUs, essential emergency and critical care can be provided in general hospital wards with minimal resources. By strengthening these systems, African healthcare providers could drastically reduce preventable deaths from conditions such as pneumonia, sepsis, and trauma.
The study calls for urgent action. Governments across Africa must prioritize essential emergency and critical care as a core component of universal health coverage. The World Health Organization should embed these interventions in its global health policies, and African health funders should support research and implementation efforts focused on these critical areas of care. Furthermore, professional medical societies must integrate these life-saving practices into clinical guidelines and training programs to ensure that frontline healthcare workers have the tools they need to save lives.
The global community has a role to play as well. The establishment of the EECC Network, a platform dedicated to sharing knowledge and best practices for essential emergency and critical care, offers hope in the fight against needless deaths in African hospitals. By taking these steps, it is possible to reduce the toll of critical illness and provide better outcomes for millions of patients across Africa.
