Summary
Background Critical illness represents a major global health-care burden and critical care is an essential component of
hospital care. There are few data describing the prevalence, treatment, and outcomes of critically ill patients in African
hospitals.
Methods This was an international, prospective, point prevalence study in acute hospitals across Africa. Investigators
examined all inpatients aged 18 years or older, regardless of location, to assess the coprimary outcomes of critical
illness and 7-day mortality. Patients were classified as critically ill if at least one vital sign was severely deranged. Data
were collected for the available resources at each hospital and care provided to patients.
Findings We included 19 872 patients from 180 hospitals in 22 African countries or territories between September, 2023
and December, 2023. The median age was 40 (IQR 29–59) years, and 11 078/19 862 (55·8%) patients were women.
There were 967/19 780 (4·9%) deaths. On census day, 2461/19 743 (12·5%) patients were critically ill, with 1688/2459
(68·6%) cared for in general wards. Among the critically ill, 507/2450 (20·7%) patients died in hospital. Mortality for
non-critically ill patients was 458/17 205 (2·7%). Critical illness on census day was independently associated with
subsequent in-hospital mortality (adjusted odds ratio 7·72 [6·65–8·95]). Of the critically ill patients with respiratory
failure, 557/1151 (48·4%) were receiving oxygen; of the patients with circulatory failure, 521/965 (54·0%) were
receiving intravenous fluids or vasopressors; and of patients with low conscious level, 387/784 (49·4%) were receiving
an airway intervention or placed in the recovery position.
Interpretation One in eight patients in hospitals in Africa are critically ill, of whom one in five dies within 7 days. Most
critically ill patients are cared for in general wards, and most do not receive the essential emergency and critical care
treatments they require. Our findings suggest a high burden of critical illness in Africa and that improving the care
of critically ill patients would have the potential to save many lives.
Critical illness - In hospital - Prevalence - Outcomes - Africa