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BMC International Health and Human Rights
Published in: BMC International Health and Human Rights 1/2014

Open Access 01-12-2014 | Research article

Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania

Authors: Hendry R Sawe, Juma A Mfinanga, Salum J Lidenge, Boniventura CT Mpondo, Silas Msangi, Edwin Lugazia, Victor Mwafongo, Michael S Runyon, Teri A Reynolds

Published in: BMC International Health and Human Rights | Issue 1/2014

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Abstract

Background

In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania.

Methods

This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC).

Results

MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009–2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%.

Conclusions

The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care to critically ill patients and likely contributing to the dauntingly high mortality rates.
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Literature
1.
Berthelsen PG, Cronqvist M: The first intensive care unit in the world: Copenhagen 1953. Acta Anaesthesiol Scand. 2003, 47 (10): 1190-1195. 10.1046/j.1399-6576.2003.00256.x.CrossRefPubMed
2.
Calvin JE, Habet K, Parrillo JE: Critical care in the United States. Who are we and how did we get here?. Crit Care Clin. 1997, 13 (2): 363-376. 10.1016/S0749-0704(05)70315-8.CrossRefPubMed
3.
Bleck TP: Historical aspects of critical care and the nervous system. Crit Care Clin. 2009, 25 (1): 153-164. 10.1016/j.ccc.2008.12.004. ixCrossRefPubMed
4.
Grenvik A, Pinsky MR: Evolution of the intensive care unit as a clinical center and critical care medicine as a discipline. Crit Care Clin. 2009, 25 (1): 239-250. 10.1016/j.ccc.2008.11.001.CrossRefPubMed
5.
Baelani I, Jochberger S, Laimer T, Otieno D, Kabutu J, Wilson I, Baker T, Dünser MW: Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers. Crit Care. 2011, 15 (1): R10-10.1186/cc9410.CrossRefPubMedPubMedCentral
6.
Dünser MW, Baelani I, Ganbold L: A review and analysis of intensive care medicine in the least developed countries. Crit Care Med. 2006, 34 (4): 1234-1242. 10.1097/01.CCM.0000208360.70835.87.CrossRefPubMed
7.
Oke DA: Medical admission into the intensive care unit (ICU) of the Lagos University Teaching Hospital. Niger Postgrad Med J. 2001, 8 (4): 179-182.PubMed
8.
Okafor UV: Challenges in critical care services in Sub-Saharan Africa: perspectives from Nigeria. Indian J Crit Care Med. 2009, 13 (1): 25-27. 10.4103/0972-5229.53112.CrossRefPubMedPubMedCentral
9.
Merah NA, Okeke CI, Olatosi JO: An audit of surgical admissions to the intensive care unit of the Lagos University Teaching Hospital (1997–2002). Niger Postgrad Med J. 2006, 13 (2): 153-156.PubMed
10.
Ohaegbulam SC, Okafor UV, Ihekire O, Elumelu E: Using the revised trauma score to predict outcome in severely head injured patients in a developing nation – a pilot study. Journal of College of Medicine. 2008, 12 (2): 51-55.
11.
Okafor UV, Aniebue U: Admission pattern and outcome in critical care obstetric patients. Int J Obstet Anesth. 2004, 13 (3): 164-166. 10.1016/j.ijoa.2004.04.002.CrossRefPubMed
12.
Okafor UV, Onwuekwe I: Disease patterns and outcome for medical neurological patients admitted to a multi-disciplinary intensive care unit. Journal of College of Medicine. 2004, 9 (2): 113-115.
13.
Dao B, Rouamba A, Ouédraogo D, Kambou T, Bazié AJ: [Transfer of obstetric patients in a pregnant and postpartum condition to an intensive care unit: eighty-two cases in Burkina Faso]. Gynecol Obstet Fertil. 2003, 31 (2): 123-126. 10.1016/S1297-9589(03)00006-7.CrossRefPubMed
14.
15.
16.
17.
Fernando J, Wickramaratne C, Dissanayake R, Kolambage S, Aminda M, Cooray N: Studying current status of intensive care services in Sri Lanka. Int J Crit Illn Inj Sci. 2012, 2 (1): 11-16. 10.4103/2229-5151.94884.CrossRefPubMedPubMedCentral
18.
Size M, Borgstein ES, Haisma HJ: One-year audit of admissions to the Intensive Care Unit of the Queen Elizabeth Central Hospital. Blantyre Malawi Medical Journal. 2005, 17 (1): 12-13.
19.
Baker T: Critical care in low-income countries. Trop Med Int Health. 2009, 14 (2): 143-148. 10.1111/j.1365-3156.2008.02202.x.CrossRefPubMed
20.
Valentin A, Ferdinande P, ESICM Working Group on Quality Improvement: Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011, 37 (10): 1575-1587. 10.1007/s00134-011-2300-7.CrossRefPubMed
21.
Wild C, Narath M: Evaluating and planning ICUs: methods and approaches to differentiate between need and demand. Health Policy. 2005, 71 (3): 289-301. 10.1016/j.healthpol.2003.12.020.CrossRefPubMed
22.
Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EAJ: Variation in critical care services across North America and Western Europe. Crit Care Med. 2008, 36 (10): 2787-2793. 10.1097/CCM.0b013e318186aec8. e1–9CrossRefPubMed
23.
Hutchings A, Durand MA, Grieve R, Harrison D, Rowan K, Green J: Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis. BMJ. 2009, 339 (nov11 2): b4353-10.1136/bmj.b4353.CrossRefPubMedPubMedCentral
24.
Bertolini G, Rossi C, Brazzi L, Radrizzani D, Rossi G, Arrighi E: The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study. Intensive Care Med. 2003, 29 (12): 2307-2311. 10.1007/s00134-003-2019-1.CrossRefPubMed
25.
Raffin TA: Indications for arterial blood gas analysis. Ann Intern Med. 1986, 105 (3): 390-398. 10.7326/0003-4819-105-3-390.CrossRefPubMed
26.
Gilbert HC, Vender JS: Arterial blood gas monitoring. Crit Care Clin. 1995, 11 (1): 233-248.PubMed
27.
Baker T, Lugazia E, Eriksen J, Mwafongo V, Irestedt L, Konrad D: Emergency and critical care services in Tanzania: a survey of ten hospitals. BMC Health Serv Res. 2013, 13: 140-10.1186/1472-6963-13-140.CrossRefPubMedPubMedCentral
28.
Moran JL, Bristow P, Solomon PJ, George C, Hart GK: Australian and New Zealand Intensive Care Society Database Management Committee (ADMC). Mortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med. 2008, 36 (1): 46-61. 10.1097/01.CCM.0000295313.08084.58.CrossRefPubMed
29.
Towey RM, Ojara S: Intensive care in the developing world. Anaesthesia. 2007, 62: 32-37. 10.1111/j.1365-2044.2007.05295.x.CrossRefPubMed
30.
Kwizera A, Dünser M, Nakibuuka J: National intensive care unit bed capacity and ICU patient characteristics in a low income country. BMC Research Notes. 2012, 5 (1): 475-10.1186/1756-0500-5-475.CrossRefPubMedPubMedCentral
31.
Mhando S, Young B, Lakhoo K: The scope of emergency paediatric surgery in Tanzania. Pediatr Surg Int. 2008, 24 (2): 219-222. 10.1007/s00383-007-2072-x.CrossRefPubMed
32.
Bowman B, Seedat M, Duncan N, Kobusingye O: Violence and injuries. Disease and Mortality in Sub-Saharan Africa [Internet]. Edited by: Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ. 2006, Washington (DC): World Bank, [cited 2014 Jun 29]. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​21290665, 2
33.
Font F, Quinto L, Masanja H, Nathan R, Ascaso C, Menendez C: Paediatric referrals in rural Tanzania: the Kilombero District Study - a case series. BMC Int Health Hum Rights. 2002, 2 (1): 4-10.1186/1472-698X-2-4.CrossRefPubMedPubMedCentral
34.
Reynolds T, Sawe HR, Lobue N, Mwafongo V: 107 most frequent adult and pediatric diagnoses among 60,000 patients seen in a New urban emergency department in Dar Es Salaam. Tanzania Annals of Emergency Medicine. 2012, 60 (4): S39-CrossRef
35.
Naghavi M, Forouzanfar MH: Burden of non-communicable diseases in sub-Saharan Africa in 1990 and 2010: global burden of diseases, injuries, and risk factors study 2010. Lancet. 2013, 381: S95-CrossRef
36.
37.
38.
Chalya PL, Gilyoma JM, Dass RM, Mchembe MD, Matasha M, Mabula JB: Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med. 2011, 19: 61-10.1186/1757-7241-19-61.CrossRefPubMedPubMedCentral
39.
Wachter RM, Russi MB, Bloch DA, Hopewell PC, Luce JM: Pneumocystis carinii pneumonia and respiratory failure in AIDS. Improved outcomes and increased use of intensive care units. Am Rev Respir Dis. 1991, 143 (2): 251-256. 10.1164/ajrccm/143.2.251.CrossRefPubMed
40.
Singh V: The burden of pneumonia in children: an Asian perspective. Paediatr Respir Rev. 2005, 6 (2): 88-93. 10.1016/j.prrv.2005.03.002.CrossRefPubMed
41.
Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H: Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008, 86 (5): 408-416. 10.2471/BLT.07.048769.CrossRefPubMedPubMedCentral
42.
De Jonge E, Bosman RJ, van der Voort PH, Korsten HH, Scheffer GJ, de Keizer NF: Intensive care medicine in the Netherlands, 1997–2001. I. Patient population and treatment outcome. Ned Tijdschr Geneeskd. 2003, 147 (21): 1013-1017.PubMed
43.
Mchembe MD, Victor M: Tetanus and its treatment outcome in Dar Es Salaam: need for male vaccination. East Afr J Public Health. 2005, 2 (2): 22-23.
Metadata
Title
Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania
Authors
Hendry R Sawe
Juma A Mfinanga
Salum J Lidenge
Boniventura CT Mpondo
Silas Msangi
Edwin Lugazia
Victor Mwafongo
Michael S Runyon
Teri A Reynolds
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC International Health and Human Rights / Issue 1/2014
Electronic ISSN: 1472-698X
DOI
https://doi.org/10.1186/1472-698X-14-26

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