PDF(Pubmed)
Abstract：
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.
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.
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.
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.
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.
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.
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.
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.
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.
摘要：
全球重大疾病负担不成比例地下降到高收入国家以外。尽管较年轻的患者人群具有相似或较低的疾病严重程度，在高收入国家以外,危重病结局较差.缺乏数据限制了试图理解和解决高收入国家以外的重症监护结果的驱动因素。
■我们的目标是表征组织，可用资源,马拉维公共部门重症监护病房的服务能力，并确定改善护理的障碍。
■我们对马拉维急诊和重症监护调查进行了二次分析，2020年1月至2月在所有四家中央医院进行了一项横断面研究，并对马拉维24家公共部门地区医院中的9家进行了简单随机抽样，以农村为主，南部非洲1,960万的低收入国家。来自重症监护病房的数据用于表征资源，进程,和护理障碍。
■在马拉维急诊和重症监护调查样本的13家医院中，有4家HDU和4家ICU。每1,000,000个集水区的重症监护床位中位数为1.4（IQR：0.9至6.7）。缺乏设备是HDU中最常见的障碍(46%[95%CI:32%至60%])。缺货是ICU中最常见的障碍（48％[CI：38％至58％]）。ICU的每单位功能呼吸机的中位数为3.0（范围：2至8），并报告了执行多种优质机械通气干预的能力。
■尽管存在明显的差距，马拉维重症监护病房报告了执行几个复杂临床过程的能力。我们的结果强调了区域在获得护理方面的不平等，并支持使用面向过程的问题来评估重症监护能力。未来的工作应侧重于城市地区以外的基本重症监护能力，并量化特定环境变量对重症监护死亡率的影响。
■我们的目标是表征组织，可用资源,马拉维公共部门重症监护病房的服务能力，并确定改善护理的障碍。
■我们对马拉维急诊和重症监护调查进行了二次分析，2020年1月至2月在所有四家中央医院进行了一项横断面研究，并对马拉维24家公共部门地区医院中的9家进行了简单随机抽样，以农村为主，南部非洲1,960万的低收入国家。来自重症监护病房的数据用于表征资源，进程,和护理障碍。
■在马拉维急诊和重症监护调查样本的13家医院中，有4家HDU和4家ICU。每1,000,000个集水区的重症监护床位中位数为1.4（IQR：0.9至6.7）。缺乏设备是HDU中最常见的障碍(46%[95%CI:32%至60%])。缺货是ICU中最常见的障碍（48％[CI：38％至58％]）。ICU的每单位功能呼吸机的中位数为3.0（范围：2至8），并报告了执行多种优质机械通气干预的能力。
■尽管存在明显的差距，马拉维重症监护病房报告了执行几个复杂临床过程的能力。我们的结果强调了区域在获得护理方面的不平等，并支持使用面向过程的问题来评估重症监护能力。未来的工作应侧重于城市地区以外的基本重症监护能力，并量化特定环境变量对重症监护死亡率的影响。
