Critical Care Units in Malawi: A Cross-Sectional Study

被引:4
作者
Sonenthal, Paul D. [1 ,2 ,3 ]
Kasomekera, Noel [4 ,5 ]
Connolly, Emilia [5 ,6 ,7 ]
Wroe, Emily B. [2 ,5 ,8 ]
Katete, Martha [5 ]
Minyaliwa, Tadala [3 ,5 ]
Marsh, Regan H. [2 ,9 ]
Banda-Katha, Grace [10 ]
Nyirenda, Mulinda [10 ,11 ]
Scott, Kirstin W. [12 ]
Bukhman, Alice [2 ,9 ]
Mukherjee, Joia [2 ,3 ]
Rouhani, Shada A. [2 ,3 ,9 ]
机构
[1] Brigham & Womens Hosp, Div Pulm & Crit Care Med, 75 Francis St, Boston, MA 02115 USA
[2] Harvard Med Sch, 25 Shattuck St, Boston, MA 02115 USA
[3] Partners Hlth, 800 Boylston St,Suite 300, Boston, MA 02199 USA
[4] Minist Hlth, POB 30377, Lilongwe 3, Malawi
[5] Abwenzi Umoyo Partners Hlth, POB 56, Neno, Malawi
[6] Univ Cincinnati, Coll Med, Div Pediat, 3230 Eden Ave, Cincinnati, OH 45267 USA
[7] Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, 3333 Burnet Ave, Cincinnati, OH 45229 USA
[8] Brigham & Womens Hosp, Div Global Hlth Equity, 75 Francis St, Boston, MA 02115 USA
[9] Brigham & Womens Hosp, Dept Emergency Med, 75 Francis St, Boston, MA 02115 USA
[10] Queen Elizabeth Cent Hosp, Adult Emergency & Trauma Ctr, POB 95, Blantyre, Malawi
[11] Kamuzu Univ Hlth Sci, Private Bag 360, Blantyre 3, Malawi
[12] Univ Washington, Dept Emergency Med, 325 Ninth St, Seattle, WA 98104 USA
关键词
critical care; health systems strengthening; facility assessment; intensive care unit; high dependency unit; Malawi; INTENSIVE-CARE; DELIRIUM; CAPACITY; SEPSIS; BURDEN; PAIN;
D O I
10.5334/aogh.4053
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: The global burden of critical illness falls disproportionately outside high-income countries. Despite younger patient populations with similar or lower disease severity, critical illness outcomes are poor outside high-income countries. A lack of data limits attempts to understand and address the drivers of critical care outcomes outside high-income countries. Objectives: We aim to characterize the organization, available resources, and service capacity of public sector critical care units in Malawi and identify barriers to improving care. Methods: We conducted a secondary analysis of the Malawi Emergency and Critical Care Survey, a cross-sectional study performed from January to February 2020 at all four central hospitals and a simple random sample of nine out of 24 public sector district hospitals in Malawi, a predominantly rural, low-income country of 19.6 million in southern Africa. Data from critical care units were used to characterize resources, processes, and barriers to care. Findings: There were four HDUs and four ICUs across the 13 hospitals in the Malawi Emergency and Critical Care Survey sample. The median critical care beds per 1,000,000 catchment was 1.4 (IQR: 0.9 to 6.7). Absent equipment was the most common barrier in HDUs (46% [95% CI: 32% to 60%]). Stockouts was the most common barriers in ICUs (48% [CI: 38% to 58%]). ICUs had a median 3.0 (range: 2 to 8) functional ventilators per unit and reported an ability to perform several quality mechanical ventilation interventions. Conclusions: Although significant gaps exist, Malawian critical care units report the ability to perform several complex clinical processes. Our results highlight regional inequalities in access to care and support the use of process-oriented questions to assess critical care capacity. Future efforts should focus on basic critical care capacity outside of urban areas and quantify the impact of context-specific variables on critical care mortality.
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页数:14
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