The ACIOS Study: A Wake-Up Call for Critical Care
The African Critical Illness Outcomes Study (ACIOS), published on the 27th February in The Lancet, offers a stark picture of the critical care situation across Africa, revealing a huge burden of critical illness alongside a significant lack of essential emergency and critical care (EECC).
Methods
International prospective study of 20,000 patients in 180 hospitals in 22 countries across Africa
Investigators examined all in-patients ≥18 years, regardless of location
Patients were classified as critically ill if any vital sign was severely deranged and followed-up for 7 days to assess outcomes
Key Findings
High Prevalence of Critical Illness: 12.5% (1 in 8) of adult inpatients in hospitals are critically ill.
Most Care is on General Wards: 69% of the critically ill are being treated in general wards rather than in specialized units
High Mortality of Critically Ill Patients: 21% of critically ill patients die in hospital within seven days, compared to just 2.7% of non-critically ill patients.
Lack of Essential Emergency and Critical Care (EECC): More than half of critically ill patients (56%) do not receive the low-cost and simple EECC they require, such as oxygen for respiratory failure and fluids for circulatory failure.
Implications
Neglected Burden: The high prevalence and mortality of critical illness have not previously been recognised.
Potential to save lives: EECC is low-cost and effective. Many deaths are preventable.
Urgent Need for Action: There is an immediate need to prioritize critical care in health systems by increasing the provision of EECC through training, process changes and implementation programs.
“Our findings should change the way we think about critical care. There is a much larger burden of critical illness than we previously thought. Simple, low-cost, essential emergency and critical care is not being provided. Many deaths are preventable.”
— Dr Tim Baker, First Author, ACIOS
Call to Action
We must transform the way that critical care is understood and delivered. The provision of Essential Emergency and Critical Care must be provided to all critically ill patients in all parts of all health facilities and EECC should become a foundation of universal health coverage. Millions of lives could be saved.
EECC Global is dedicated to this work. By promoting and implementing EECC in hospitals and health systems, we will realise the vision “no one should die in hospital of a cause that EECC could prevent”. Together we could save the lives of 1 million people every year.
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ACIOS was a collaboration between universities in Tanzania, Ethiopia, Uganda, South Africa and the UK in the APPRISE partnership, funded by the National Institute for Health and Care Research (NIHR).
Baker T and The ACIOS Investigators (2025). ‘The African Critical Illness Outcomes Study (ACIOS): A point prevalence study of critical illness in 22 nations in Africa’. The Lancet, 405: 715–24