Critical care resources in the Solomon Islands: a cross-sectional survey

Mia Westcott,Alexandra Lc Martiniuk,Robert A Fowler,Neill Kj Adhikari,Tenneth Dalipanda

doi:10.1186/1472-698x-12-1

Abstract

BackgroundThere are minimal data available on critical care case-mix, care processes and outcomes in lower and middle income countries (LMICs). The objectives of this paper were to gather data in the Solomon Islands in order to gain a better understanding of common presentations of critical illness, available hospital resources, and what resources would be helpful in improving the care of these patients in the future.MethodsThis study used a mixed methods approach, including a cross sectional survey of respondents' opinions regarding critical care needs, ethnographic information and qualitative data.ResultsThe four most common conditions leading to critical illness in the Solomon Islands are malaria, diseases of the respiratory system including pneumonia and influenza, diabetes mellitus and tuberculosis. Complications of surgery and trauma less frequently result in critical illness. Respondents emphasised the need for basic critical care resources in LMICs, including equipment such as oximeters and oxygen concentrators; greater access to medications and blood products; laboratory services; staff education; and the need for at least one national critical care facility.ConclusionsA large degree of critical illness in LMICs is likely due to inadequate resources for primary prevention and healthcare; however, for patients who fall through the net of prevention, there may be simple therapies and context-appropriate resources to mitigate the high burden of morbidity and mortality. Emphasis should be on the development and acquisition of simple and inexpensive tools rather than complicated equipment, to prevent critical care from unduly diverting resources away from other important parts of the health system.

Highlights

There are minimal data available on critical care case-mix, care processes and outcomes in lower and middle income countries (LMICs)
Despite a large volume of critical care research in highincome countries over the last two decades–on epidemiology and therapies for common syndromes such as sepsis and acute lung injury, organisation of intensive care units (ICUs) and models of care delivery, and knowledge translation–virtually no research has occurred in settings with the greatest burden of illness and least capacity for care [1,2]
We examined the World Health Organisation (WHO) web site [5,10,12] and the Solomon Islands National Health Strategic Plan [14]

Summary

Introduction

There are minimal data available on critical care case-mix, care processes and outcomes in lower and middle income countries (LMICs). The objectives of this paper were to gather data in the Solomon Islands in order to gain a better understanding of common presentations of critical illness, available hospital resources, and what resources would be helpful in improving the care of these patients in the future. In developed countries, caring for critically ill patients involves a coordinated system of triage, emergency management and ICUs [3]. Such care is viewed as complex and unaffordable for many LMICs, yet much of this. In 2009, health expenditure represented 5.4% of the gross domestic product (GDP), or $147 international dollars per person [10]

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