When someone gets seriously ill, hospitals are expected to provide life-saving care. However, in many African countries, intensive care units are rare. Critical patients are being treated in hospital wards, with limited availability of essential emergency situations and critical care.
A serious illness refers to a life-threatening condition in which at least one important organ, such as the heart, lungs, or brain, is failing. It can result from any underlying condition, including infection, injuries, infectious diseases such as heart attacks and strokes, and can affect people of all ages.
In a high-resource environment, several critically ill patients are treated in intensive care units. They receive continuous surveillance, oxygen support, medications to stabilize blood pressure, and other life-saving treatments. To date, most data on serious illnesses and emergency care in Africa comes from small in-hospital studies. These studies suggested serious problems.
For example, a study in Uganda found that 11.7% of hospitalized patients were seriously ill and there was a 22.6% chance of death within a week. However, there was no large-scale study showing how widespread this has been across the continent.
Therefore, in collaboration with clinical researchers across Africa, we conducted a study of serious disease outcomes in Africa and provided the first large-scale perspective on the status of serious disease care across the continent.
The study is based on a network of clinicians, researchers and policymakers that have grown over more than a decade and describes how to identify and treat critically ill patients.
The findings published in the Lancet are impressive. One in eight hospitalized patients in Africa are seriously ill, with over two-thirds of seriously ill in general wards, with one in five people dead within a week.
Most of these patients do not receive essential emergency or emergency care, such as oxygen or liquids, which can save lives.
What we found
The African Serious Illness Outcome Survey examined 20,000 patients at one point in 180 hospitals in 22 African countries. Countries across the continent included Tunisia in the north to South Africa, and from Ghana in the west to Tanzania in the east.
Between September and December 2023, all adult inpatients from each hospital were examined in one day to collect clinical status and treatment data, followed by in-hospital outcomes one week later.
The key findings are as follows:
12.5% of hospital inpatients are seriously ill, with 69% of critically ill patients being treated in hospital wards, and over half of critically ill patients not more than half of critically ill patients, making them eight times more likely to die in hospital than others.
The study also revealed the gaps in the most basic life-saving interventions.
Only 48% of patients with respiratory failure were only patients receiving oxygen therapy, and 54% of patients with circulatory failure (e.g. shock) were given, and fewer than half of patients with risky consciousness were given airway protection or a fluid or medication to stabilize fewer than half of patients who were placed in a recovery position.
These findings highlight clear and urgent issues. Many critically ill patients in Africa are not receiving critical treatments that can continue to survive.
What can you do?
The study suggests that hospitals can save thousands of lives if they have better access to essential emergency situations and critical care. This is a simple, low-cost intervention set that can prevent death from serious illness.
Care interventions include:
Ensuring oxygen in oxygen allows patients struggling to provide liquids or medications to access liquids or medications to stabilize blood pressure training healthcare workers with basic life support techniques to manage unconscious patients.
Unlike high-tech intensive care units, a standard ward with minimal resources can provide essential emergency and critical care.
Enhanced these systems can dramatically reduce preventable deaths from conditions such as pneumonia, sepsis, and trauma.
Emergency action is needed
The study sheds light on the healthcare crisis affecting millions of people, but it remains largely overlooked.
All critically ill patients should receive basic life-saving care they need, no matter where they are being treated.
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We are seeking urgent action.
African governments need to make essential emergencies and critical care at the core of universal health insurance. It should be integrated into the policy and health benefits package. The World Health Organization must incorporate essential emergency situations and critical care measures into the resolution. African health funders need to support research and implementation of essential emergency situations and critical care. Professional healthcare communities and institutions should include this care in clinical guidelines and training. Frontline healthcare workers need to have the tools they need to save lives.
The EECC Network, a global community dedicated to sharing knowledge, research and best practices, has been launched to prevent unnecessary death.
* Nick Leech, who works on behalf of EECC Global to promote critical emergency situations and critical care, contributed to this article.
Tim Baker, Associate Professor, Karolinska Institute
Karima Khalid, lecturer, researcher, anesthesiology and critical care consultant, Muhimbili Health and Allied Sciences
