Hospitals across the continent have few resources. A new study shows the consequences.
The interim results of an Africa-wide study of hospitalized Covid-19 patients show that the continent has much higher mortality rates in intensive care units than other parts of the world, and that the higher mortality rates can best be explained by scarce resources.
Covid-19 produced large amounts of data within a short period of time, but our knowledge of how the SARS-CoV-2 virus affected hospitals in Africa and other countries where health resources are limited is scarce.
The study, entitled “An African multi-center evaluation of patient care and clinical outcomes for patients with COVID-19 infection admitted to high-care or intensive care units”, is awaiting peer review. The researchers collected data from patients with Covid-19 infections admitted to high-care or intensive care units (ICUs) in six African countries.
The study, led by Professor Bruce Biccard of UCT, included 1,243 patients in 38 hospitals in Egypt (9), Ethiopia (7), Ghana (2), Libya (7), Nigeria (2) and South Africa between April and early April. (11) included. September. The study continues until December, but the authors of the study decided to analyze data as soon as a mortality was reached in the participating hospitals.
The aim of the study is to find out how Covid-19 patients admitted to intensive care units are affected by the unit’s resources, comorbidities and critical care.
631 of the 1,153 adult patients (55%) referred to intensive care or high care units after suspected or known COVID-19 infection in the hospitals studied died. By comparison, the global mortality rate of patients admitted to intensive care is 31%. In this hospital need, the mortality rate is between 18 and 29 deaths per 100 admissions higher than in the rest of the world.
What explains the higher mortality rate among African patients?
African hospitals usually have far fewer resources than hospitals in Europe and North America. Only half of the patients referred to critical care units were able to obtain an ICU bed. It is estimated that Africa has 0.8 critical beds per 100,000 people. According to the study, this low amount of beds can lead to only very sick patients being admitted to critical care.
Once you have been in critical care, the resources available for patient care are limited, and the use of these scarce resources is further limited.
Only 60% of the hospitals were able to offer dialysis, and this was used in only 8.7% of the patients. Global studies indicate that 23.2% of patients requiring critical care also require dialysis, which according to the study means that twice as many patients in this study needed dialysis.
Similar findings have been made with pruning (thus laying patients on their stomachs, which reduces the mortality rate of Covid-19). Protection was only available to 60% of patients, and only to 9.6% of patients with ventilation. Although it may seem easy to prune, it is actually a difficult process for patients in ICU on ventilators, and many units may not have had the manpower or confidence to do so. According to the study, “at least” four times more patients had to be strangled while on ventilators.
The study was able to show with some confidence that certain factors do not explain the higher African mortality rate. These include comorbidities, including hypertension, diabetes, HIV, and higher body mass index (some degree of obesity). (Note: Some of these factors are related to a higher Covid-19 mortality rate, but this does not explain why mortality rates in African hospitals are higher.)
According to the authors, this is “the only study of a population with a high HIV burden”. The authors cautiously state that the data suggest that HIV / AIDS is not a major contributor to Covid-19 deaths.
While African hospitals have relatively lower numbers of medical staff than the rest of the world, they have not been directly identified as an explanation for higher deaths. The authors did note that a limited number of staff members may explain why only half of the patients referred were admitted to critical care.
The study makes an effort to indicate its limitations. This cannot explain why large numbers of patients died without receiving fundamental treatments, such as oxygen (1/6 deaths) or inotropics (1/2 – these are drugs that support circulation). Only six countries were able to meet the ethical and regulatory requirements out of 24 countries that showed interest in participating, which means the results may not be universal. It is nonetheless the largest collection of critically ill patients in environments that do not have enough resources.
Furthermore, the hospitals participating in the study are mostly tertiary health care centers, which can provide significantly more services. This increases the possibility that mortality rates for patients admitted to critical care in Africa are even higher than reported here.
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