The African Critical Illness Outcome Study (ACIOS) is the largest study to date on critical illness in Africa, highlighting a significant burden of life-threatening conditions in hospitals across the continent. The study aimed to assess the prevalence, management, and outcomes of critically ill patients while identifying gaps in essential emergency and critical care (EECC).
Associate Professor Arthur Kwizera (College of Health Sciences, Makerere University) was a Co-Investigator and National Lead for Uganda in partnership with researchers from Europe and Africa.
A Research publication detailing the study was published in the Lancet and can be downloaded here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02846-0/fulltext
Key Findings
• High Prevalence of Critical Illness: One in eight hospital inpatients (12.5%) in Africa are critically ill.
• High Mortality Rate: Critically ill patients face a 21% seven-day mortality rate, significantly higher than the 2.7% mortality for non-critically ill patients.
• Limited Access to Intensive Care: Nearly 70% of critically ill patients receive care in general hospital wards rather than intensive care units (ICUs) or high-dependency units.
• Insufficient Emergency Care: Over 56% of critically ill patients do not receive essential emergency and critical care (EECC), including oxygen therapy, intravenous fluids, and airway management.
Significance
The study provides first-of-its-kind epidemiological data on critical illness across multiple African countries. The findings highlight severe gaps in emergency care infrastructure and resources, emphasizing the need for investment in low-cost, lifesaving interventions to reduce mortality. Addressing these gaps through EECC can save many lives without requiring high-cost ICU infrastructure.
Study Methodology
ACIOS was a multi-country prospective study, involving 20,000 patients from 180 hospitals in 22 African countries. Investigators assessed all adult inpatients (≥18 years) across different hospitals, identifying those with severely deranged vital signs. Patients were then followed up over seven days to determine their health outcomes. Additionally, the study collected hospital resource availability data to assess the readiness of facilities to provide critical care.
Funding and Collaboration
The study was funded by the National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850) with Professors Rupert Pearse and Bruce Biccard as PIs, and conducted in partnership with Makerere University (Uganda) led by Associate Professor Arthur Kwizera (as Co-I and national lead), Busitema University (Uganda) led by Dr Adam Hewitt Smith, University of Cape Town (South Africa)led by Bruce Biccard, Muhimbili University of Health and Allied Sciences (Tanzania) Led by Dr Tim Baker, Queen Mary University of London (UK), the African Perioperative Research Group, and the EECC Network.
Policy Implications
The findings call for urgent action by health policymakers and hospital administrators to:
• Strengthen emergency and critical care services in general hospital wards.
• Improve the availability of essential life-saving interventions such as oxygen therapy and IV fluids.
• Train healthcare workers in essential emergency and critical care (EECC) protocols to enhance patient outcomes.
Relevance to Uganda
Uganda, like many African countries, faces a severe shortage of ICU beds and critical care services. The study underscores the urgent need for investment in critical care infrastructure and workforce training to improve survival rates among critically ill patients.
Conclusion
The ACIOS study is a wake-up call for Africa’s healthcare systems, urging greater focus on low-cost, high-impact interventions that can significantly reduce mortality among critically ill patients. By prioritizing essential emergency and critical care, health systems can improve survival rates without requiring large investments in ICU infrastructure