Tim Baker, Associate Professor, Karolinska Institutet, Karima Khalid, Lecturer, researcher, and consultant in anaesthesiology and critical care, Muhimbili University of Health and Allied Sciences
When someone falls critically ill, hospitals are expected to provide life-saving care. But in many African countries, intensive care units are rare. Critically ill patients are treated in general hospital wards, and the provision of essential emergency and critical care is limited.
Critical illness refers to any life-threatening condition where at least one vital organ – such as the heart, lungs, or brain – is failing. It can arise from any underlying condition including infections, injuries, or non-communicable diseases such as heart attacks and strokes, and can affect anyone of any age.
In high-resourced settings some critically ill patients are treated in intensive care units. They receive continuous monitoring, oxygen support, medication to stabilise their blood pressure, and other life-saving treatments. Until now, most data on critical illness and critical care in Africa has come from small, single-hospital studies. These studies hinted at a serious problem.
For example, a study in Uganda found that 11.7% of inpatients were critically ill, with a 22.6% chance of dying within a week. However, there was no large-scale research showing how widespread this was across the continent.
That is why we, a collaboration of clinical researchers across Africa, conducted the African Critical Illness Outcomes Study, providing the first large-scale look at the state of critical illness care across the continent.
The study builds on a network of clinicians, researchers and policy makers that has been growing for over a decade now, working out how to identify and treat patients who are critically ill.
The findings, published in The Lancet, are striking. One in eight hospital inpatients in Africa is critically ill, over two-thirds of the critically ill are in general wards, and one in five dies within a week.
Most of these patients do not receive the essential emergency and critical care such as oxygen and fluids that could save their lives.
What we found
The African Critical Illness Outcomes Study investigated 20,000 patients at one point in time in 180 hospitals in 22 countries across Africa. Countries throughout the continent were included, from Tunisia in the north to South Africa in the south, from Ghana in the west to Tanzania in the east.
Between September and December 2023, all adult inpatients in each hospital were examined on a single day to collect data about their clinical condition and treatments, and then a week later, their in-hospital outcomes.
The key findings were:
12.5% of hospital inpatients were critically ill
69% of critically ill patients were treated in general hospital wards, not intensive care units
more than half of critically ill patients didn’t receive the treatments they needed
critically ill patients were eight times more likely to die in hospital than other patients.
The study also revealed gaps in the most basic life-saving interventions:
only 48% of patients with respiratory failure received oxygen therapy
just 54% of patients with circulatory failure (such as shock) received fluids or medications to stabilise blood pressure
less than half of patients with a dangerously low level of consciousness received airway protection or were placed in the recovery position.
These findings highlight a clear and urgent problem: many critically ill patients in Africa are not receiving the essential treatments that could keep them alive.
What can be done?
The study suggests that thousands of lives could be saved if hospitals had better access to essential emergency and critical care. This is a set of simple, low-cost interventions that can prevent deaths from critical illness.
The care interventions include:
ensuring oxygen is available for patients struggling to breathe
providing fluids or medications to stabilise blood pressure
training healthcare workers in basic life-support techniques to manage unconscious patients.
Unlike high-tech intensive care unit treatments, essential emergency and critical care can be given in general wards with minimal resources.
Strengthening these systems could dramatically reduce preventable deaths from conditions such as pneumonia, sepsis and trauma.
Urgent action is needed
This study sheds light on a healthcare crisis affecting millions of people, yet one that has remained largely overlooked.
Every critically ill patient, no matter where they are treated, should receive the basic life-saving care they need.
We call for urgent action.
Governments in Africa should make essential emergency and critical care a core part of universal health coverage. It should be integrated into policies and health benefit packages.
The World Health Organization should embed essential emergency and critical care measures into its resolutions.
African health funders should support studies and implementation of essential emergency and critical care.
Professional medical societies and institutions should include this care in clinical guidelines and training. Frontline healthcare workers must have the tools they need to save lives.
The EECC Network, a global community dedicated to sharing knowledge, research and best practices, has been started to help prevent needless deaths.
* Nick Leech, who works on the promotion of essential emergency and critical care on behalf of EECC Global, contributed to this article.
Tim Baker declares technical consultancies with UNICEF, the World Bank, USAID, and PATH, has received research funding from Wellcome Trust and the National Institute for Health and Care Research and is a board member at the non-profit organisation EECC Global.
Karima Khalid is a board member of EECCGlobal
