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. 2023 Jul 27;18(7):e0284245.
doi: 10.1371/journal.pone.0284245. eCollection 2023.

Organisation, staffing and resources of critical care units in Kenya

Wambui Mwangi  1   2 , Ronnie Kaddu  2   3 , Carolyne Njoki Muiru  2   4   5 , Nabukwangwa Simiyu  2   6 , Vishal Patel  7 , Demet Sulemanji  2   5 , Dorothy Otieno  2 , Stephen Okelo  2   8 , Idris Chikophe  2   9 , Luigi Pisani  10 , Dilanthi Priyadarshani Gamage Dona  10 , Abi Beane  10   11 , Rashan Haniffa  10   11 , David Misango  2   12 , Wangari Waweru-Siika  2   12 ; Kenya Critical Care Registry Investigators
Affiliations

Organisation, staffing and resources of critical care units in Kenya

Wambui Mwangi et al. PLoS One. .

Abstract

Objective: To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors.

Materials and methods: An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care.

Results: The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A total of 598 critical care beds were reported with a median of 6 beds (interquartile range [IQR] 5-11) per unit, with 26% beds (n = 157) being non functional. The proportion of ICU beds to total hospital beds was 3.8% (IQR 1.9-10.4). Most of the units (80%, n = 48) were mixed/general units with an open model of care (60%, n = 36). Consultants-in-charge were mainly anesthesiologists (69%, n = 37). The nurse-to-bed ratio was predominantly 1:2 with half of the nurses formally trained in critical care. Most units (83%, n = 47) had a dedicated ventilator for each bed, however 63% (n = 39) lacked high flow nasal therapy. While basic multiparametric monitoring was ubiquitous, invasive blood pressure measurement capacity was low (3% of beds, IQR 0-81%), and capnography moderate (31% of beds, IQR 0-77%). Blood gas analysers were widely available (93%, n = 56), with 80% reported as functional. Differences between the public and private sector were narrow.

Conclusion: This study shows an established critical care network in Kenya, in terms of staffing density, availability of basic monitoring and ventilation resources. The public and private sector are equally represented albeit with modest differences. Potential areas for improvement include training, use of invasive blood pressure and functionality of blood gas analysers.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of critical care units and ICU beds by hospital status.
Abbreviations: PNFP, private not for profit.
See this image and copyright information in PMC

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