SEARCHCROSS-SECTIONALcritical care, epidemiology

cross-sectional·critical care, epidemiology, public health, observational study·PMC10557270

Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study

BMC Health Services Research · 13 authors, 12 centres

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TL;DR

This cross-sectional study assessed critical care capacity on medical wards in 13 Malawian hospitals. It found that while no ward met full ICU criteria, many had key resources, and gaps like stock-outs and personnel shortages highlight areas for targeted improvement with modest inputs.

Full summary

779 CHARS

This secondary analysis of the Malawi Emergency and Critical Care survey used data from 13 public hospitals (9 district, 4 central) collected in early 2020. It assessed staffing, infrastructure, equipment, and systems on medical wards, comparing district versus central hospitals. The study evaluated if wards met World Federation of Intensive and Critical Care Medicine level 1 ICU criteria and analyzed readiness for essential care bundles. Results showed no medical wards met the full ICU definition, but many fundamental resources were available. District hospitals more frequently reported stock-outs (29% vs 6%) and personnel shortages (40% vs 29%), while central hospitals reported more training barriers (68% vs 45%), though no differences were statistically significant.

STUDY TYPE

cross-sectional

SPECIALTY

critical care

SUMMARISED BY

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100% · A

ORIGINAL PAPER

PMC10557270

Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study

BMC Health Services Research

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ABSTRACT

Introduction As low-income countries (LICs) shoulder a disproportionate share of the world’s burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes. Methods This was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher’s exact test. Results From the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant. Conclusion Despite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-023-10014-8.

CITATION EXPORT

Emilia Connolly, Noel Kasomekera, Paul D. Sonenthal et al.. Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study. BMC Health Services Research. (2023). https://doi.org/10.1186/s12913-023-10014-8

AUTHORS

13 · 12 CENTRES

Emilia Connolly, Noel Kasomekera, Paul D. Sonenthal, Mulinda Nyirenda, Regan H. Marsh, Emily B. Wroe, Kirstin W. Scott, Alice Bukhman, Tadala Minyaliwa, Martha Katete, Grace Banda, Joia Mukherjee, Shada A. Rouhani

1Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
2https://ror.org/01e3m7079grid.24827.3b0000 0001 2179 9593Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267 USA
3grid.239573.90000 0000 9025 8099Division of Hospital Medicine, Cincinnati Children’s Hospital, 3333 Burnet Ave, Cincinnati, OH 45229 USA
4grid.415722.70000 0004 0598 3405Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
5https://ror.org/05tsvnv68grid.417182.90000 0004 5899 4861Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199 USA
6https://ror.org/04b6nzv94grid.62560.370000 0004 0378 8294Brigham & Women’s Hospital, Division of Pulmonary & Critical Care, 75 Francis St, Boston, MA 02115 USA
7grid.38142.3c000000041936754XHarvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
8https://ror.org/025sthg37grid.415487.b0000 0004 0598 3456Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
9https://ror.org/04vtx5s55grid.10595.380000 0001 2113 2211University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
10https://ror.org/04b6nzv94grid.62560.370000 0004 0378 8294Brigham & Women’s Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA 02115 USA
11https://ror.org/04b6nzv94grid.62560.370000 0004 0378 8294Brigham & Women’s Hospital, Division of Global Health Equity, 75 Francis St, Boston, MA 02115 USA
12grid.34477.330000000122986657Department of Emergency Medicine, University of Washington, Seattle, USA