Abstract
BackgroundIn 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.MethodsThis 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).ResultsMNH 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%.ConclusionsThe 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.
Highlights
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
In this study we aim to describe the disease patterns and clinical outcomes of patients admitted to the ICUs of these Tanzanian referral hospitals
This is a retrospective review of patients admitted to the ICUs of the four public tertiary referral hospitals of Tanzania (MNH, Kilimanjaro Christian Medical Centre (KCMC), Bugando Medical Centre (BMC), and Mbeya Referral Hospital (MRH)) for the three year period from 1 January 2009 to 31 December 2011
Summary
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. In sub-Saharan Africa, ICUs have varying qualities and quantities of infrastructure necessary for the provision of Tanzania, a low-income country in East Africa with a population of 44 million, has four main referral hospitals, which are located in zones so as to serve as a tertiary level referral centers. These hospitals are Kilimanjaro Christian Medical Centre (KCMC) in the Northern zone, Bugando Medical Centre (BMC) in the Western zone, Mbeya Referral Hospital (MRH) in the Southern highlands zone, and Muhimbili National Hospital (MNH) which serves the coastal zone (Figure 1). A small number of private hospitals with semi-tertiary capacity provide specialized ICU care; these services are not freely accessible to the general public
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