Bridging the Critical Care Gap in Africa: Insights from the ACIOS Study
The African Critical Illness Outcomes Study (ACIOS), published in The Lancet, reveals the scale of critical illness across African hospitals and the urgent need for universal access to essential emergency and critical care (EECC).
The ACIOS commentary from Nazir I Lone, John A Masterson, Swagata Tripathy was published alongside the original study, and offers further insight into the problem and a path forwards.
The Burden of Critical Illness in Africa
Critical illness is a major but often overlooked public health challenge in Africa. The ACIOS study examined nearly 20,000 adult patients across 22 African countries, finding that 12.5% of inpatients were critically ill on the day of the study. Despite this high prevalence, only 17.1% of these patients received care in an ICU, with the majority treated in general wards without adequate resources.
The consequences of this care gap are severe. Critically ill patients in African hospitals face a 20.7% mortality rate within seven days, compared to just 2.7% for non-critically ill patients. The study highlights that over half (55.6%) of critically ill patients received partial or no EECC, and only 7.5% of hospitals had access to all essential EECC resources. These findings make it clear: a lack of timely and appropriate care for critically ill patients is costing lives.
Why Essential Emergency and Critical Care Matters
EECC focuses on simple, low-cost interventions that can significantly improve survival rates. These include monitoring vital signs, administering oxygen and IV fluids, managing airways, and providing vasoactive medication. Unlike advanced ICU care, which requires expensive technology and specialist training, EECC can be delivered in general hospital wards by trained healthcare workers at a fraction of the cost.
The ACIOS study reinforces the importance of EECC by demonstrating that many critically ill patients do not require ICU-level interventions but do need timely, basic life-saving treatments. Strengthening EECC in all hospital wards could drastically reduce mortality rates and improve patient outcomes.
Challenges and the Path Forward
A key challenge highlighted in the study is the vast discrepancy between the need for critical care and the resources available in African hospitals. The scarcity of critical care beds is compounded by limited access to trained personnel and essential equipment. This disparity is not unique to Africa—many low- and middle-income countries (LMICs) face similar challenges.
Addressing this crisis requires a multi-faceted approach:
Infrastructure and Resource Allocation: Hospitals must prioritize investment in EECC resources, ensuring that essential interventions are available outside ICUs.
Workforce Training: Expanding educational programs for healthcare workers can improve early recognition and management of critical illness.
Policy and Advocacy: Governments and global health organizations must recognize EECC as a core component of universal healthcare and allocate funding accordingly.
Innovation and Research: Developing and improving data collection can help track progress and refine strategies for delivering EECC.
A Call to Action
The ACIOS study provides a compelling case for urgent investment in EECC. As the burden of non-communicable diseases, infectious diseases, and public health emergencies continues to rise, strengthening critical care services must be a priority. Ensuring that every hospital—regardless of location or resources—can provide life-saving interventions should be an imperative.
By expanding EECC, we can save countless lives and create a more resilient healthcare system across Africa..