Abstract
BACKGROUND:
The burden of critical illness in low-income countries is high and expected to rise. This has implications for wider public health measures including maternal mortality, deaths from communicable diseases, and the global burden of disease related to injury. There is a paucity of data pertaining to the provision of critical care in low-income countries. This study provides a review of critical care services in Ethiopia.
METHODS:
Multicenter structured onsite surveys incorporating face-to-face interviews, narrative discussions, and on-site assessment were conducted at intensive care units (ICUs) in September 2020 to ascertain structure, organization, workforce, resources, and service capacity. The 12 recommended variables and classification criteria of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) taskforce criteria were utilized to provide an overview of service and service classification.
RESULTS:
A total of 51 of 53 (96%) ICUs were included, representing 324 beds, for a population of 114 million; this corresponds to approximately 0.3 public ICU beds per 100,000 population. Services were concentrated in the capital Addis Ababa with 25% of bed capacity and 51% of critical care physicians. No ICU had piped oxygen. Only 33% (106) beds had all of the 3 basic recommended noninvasive monitoring devices (sphygmomanometer, pulse oximetry, and electrocardiography). There was limited capacity for ventilation (n = 189; 58%), invasive monitoring (n = 9; 3%), and renal dialysis (n = 4; 8%). Infection prevention and control strategies were lacking.
CONCLUSIONS:
This study highlights major deficiencies in quantity, distribution, organization, and provision of intensive care in Ethiopia. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority.
The burden of critical illness in low-income countries is high and expected to rise. This has implications for wider public health measures including maternal mortality, deaths from communicable diseases, and the global burden of disease related to injury. There is a paucity of data pertaining to the provision of critical care in low-income countries. This study provides a review of critical care services in Ethiopia.
METHODS:
Multicenter structured onsite surveys incorporating face-to-face interviews, narrative discussions, and on-site assessment were conducted at intensive care units (ICUs) in September 2020 to ascertain structure, organization, workforce, resources, and service capacity. The 12 recommended variables and classification criteria of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) taskforce criteria were utilized to provide an overview of service and service classification.
RESULTS:
A total of 51 of 53 (96%) ICUs were included, representing 324 beds, for a population of 114 million; this corresponds to approximately 0.3 public ICU beds per 100,000 population. Services were concentrated in the capital Addis Ababa with 25% of bed capacity and 51% of critical care physicians. No ICU had piped oxygen. Only 33% (106) beds had all of the 3 basic recommended noninvasive monitoring devices (sphygmomanometer, pulse oximetry, and electrocardiography). There was limited capacity for ventilation (n = 189; 58%), invasive monitoring (n = 9; 3%), and renal dialysis (n = 4; 8%). Infection prevention and control strategies were lacking.
CONCLUSIONS:
This study highlights major deficiencies in quantity, distribution, organization, and provision of intensive care in Ethiopia. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority.
| Original language | English |
|---|---|
| Pages (from-to) | 930-937 |
| Number of pages | 8 |
| Journal | Anesthesia and Analgesia |
| Volume | 134 |
| Issue number | 5 |
| Early online date | 5 Nov 2021 |
| DOIs | |
| Publication status | Published - May 2022 |
Bibliographical note
Funding: This study was funded by the Ethiopian Ministry of Health Emergency and Critical Care Directorate. A.B. and R.H. are funded in whole, or in part, by the Wellcome Trust [220211] and UKRI GECO Grant MR/V030884/1 for their contribution to this study.ACKNOWLEDGMENTS
The authors wish to thank all hospital CEO’s and medical directors for their honest and cooperative response, and data collectors and coordinators who visited facilities for their assistance with data col- lection. We thank Ermiyas Belay, MSc, from Wolkite University, Ethiopia, and Dilanthi Gamage from Network for Improving Critical Care Systems and Training (NICST), Sri Lanka for their assistance in analyzing the data. We are particularly grateful to Prof Bruce Biccard, PhD, from University of Cape Town for his assistance in presubmission manuscript review.
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