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. 2023 Aug 3;89(1):51.
doi: 10.5334/aogh.4053. eCollection 2023.

Critical Care Units in Malawi: A Cross-Sectional Study

Paul D Sonenthal  1   2   3 , Noel Kasomekera  4   5 , Emilia Connolly  5   6   7 , Emily B Wroe  2   5   8 , Martha Katete  5 , Tadala Minyaliwa  5 , Regan H Marsh  2   3   9 , Grace Banda-Katha  10 , Mulinda Nyirenda  10   11 , Kirstin W Scott  12 , Alice Bukhman  2   9 , Joia Mukherjee  2   3 , Shada A Rouhani  2   3   9
Affiliations

Critical Care Units in Malawi: A Cross-Sectional Study

Paul D Sonenthal et al. Ann Glob Health. .

Abstract

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.

Keywords: Malawi; critical care; facility assessment; health systems strengthening; high dependency unit; intensive care unit.

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Conflict of interest statement

Paul D Sonenthal received support for this study from Brigham and Women’s Hospital, Division of Pulmonary and Critical Care Medicine, in the form of a faculty research fund. He also reports consulting fees from the University of California-San Francisco/Sustaining Technical and Analytic Resources, and funding from Unitaid (Grant SPHQ15-LOA-045). Shada A Rouhani received support for this study from Brigham and Women’s Hospital, Department of Emergency Medicine, in the form of a seed grant. She also reports consulting fees from Partners In Health and the World Health Organization. Joia S Mukherjee is the Chief Medical Officer at Partners In Health and sits on the boards of Village Health Works (Burundi/Muso and Mali), the Institute for Justice and Democracy in Haiti, and Free Speech for People. The authors have no other interests to declare.

Figures

Box plots showing frequencies of six common barrier categories in HDUs and ICUs
Figure 1
Barriers in critical care units: Box plots of participant level data showing relative frequencies of the six most common barrier categories in HDUs (n = 11). and ICUs (n = 12) for signal functions from Table 3 (top panel) and Table 4 (bottom panel). Estimates for each participant were calculated taking the number of times each barrier was identified by the participant divided by the number of times the participant was probed for barriers (i.e., number of times participant responded generally unavailable or somewhat available). Reported p-values are for Fisher’s exact test.
See this image and copyright information in PMC

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