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Retrospective Descriptive Study of an Intensive Care Unit at a Ugandan Regional Referral Hospital

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Abstract

Background

We describe delivery and outcomes of critical care at Mbarara Regional Referral Hospital, a Ugandan secondary referral hospital serving a large, widely dispersed rural population.

Methods

Retrospective observational study of ICU admissions was performed from January 2008 to December 2011.

Results

Of 431 admissions, 239 (55.4 %) were female, and 142 (33.2 %) were children (<18 years). The median length of stay was 2 (IQR 1–4) days, with 365 patients (85 %) staying less than 8 days. Indications for admission were surgical 49.3 % (n = 213), medical/pediatric 27.4 % (n = 118), or obstetrical/gynecological 22.3 % (n = 96). The overall mortality rate was 37.6 % (162/431) [adults 39.3 % (n = 113/287), children 33.5 % (n = 48/143), unspecified age 100 % (n = 1/1)]. Of the 162 deaths, 76 (46.9 %) occurred on the first, 20 (12.3 %) on the second, 23 (14.2 %) on the third, and 43 (26.5 %) on a subsequent day of admission. Mortality rates for common diagnoses were surgical abdomen 31.9 % (n = 29/91), trauma 45.5 % (n = 30/66), head trauma 59.6 % (n = 28/47), and poisoning 28.6 % (n = 10/35). The rate of mechanical ventilation was 49.7 % (n = 214/431). The mortality rate of ventilated patients was 73.5 % (n = 119/224). The multivariate odd ratio estimates of mortality were significant for ventilation [aOR 6.15 (95 % CI 3.83–9.87), p < 0.0001] and for length of stay beyond seven days [aOR 0.37 (95 % CI 0.19–0.70), p = 0.0021], but not significant for decade of age [aOR 1.06 (95 % CI 0.94–1.20), p = 0.33], gender [aOR 0.61(95 % CI 0.38–0.99), p = 0.07], or diagnosis type [medical vs. surgical aOR 1.08 (95 % CI 0. 63–1.84), medical vs. obstetric/gynecology aOR 0.73 (95 % CI 0.37–1.43), p = 0.49].

Conclusions

The ICU predominantly functions as an acute care unit for critically ill young patients, with most deaths occurring within the first 48 h of admission. Expansion of critical care capacity in low-income countries should be accompanied by measurement of the nature and impact of this intervention.

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Acknowledgments

We wish to thank Manfred Amanya (data entry) and Nicholas Musinguzi M.Sc. and K. Trudy Poon M.Sc. (statistical analysis).

Funding

Funding was provided by MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.

Author information

Authors and Affiliations

  1. Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara, Uganda

    Stephen S. Ttendo & Emmanuel Munyarugero

  2. Department of Pediatrics, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, USA

    Adam Was

  3. Department of Surgery, Brigham and Woman’s Hospital, Boston, MA, USA

    Mark A. Preston

  4. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Vanessa B. Kerry

  5. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Paul G. Firth

Authors
  1. Stephen S. Ttendo
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  2. Adam Was
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  3. Mark A. Preston
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  4. Emmanuel Munyarugero
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  5. Vanessa B. Kerry
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  6. Paul G. Firth
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Corresponding author

Correspondence to Paul G. Firth.

Appendices

Appendix 1

See Fig. 3.

Fig. 3
figure 3

Survival curve by gender. Product-limit survival estimates, with 95 % Hall–Wellner bands. Each step down represents a death. Right censored at 30 days

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Appendix 2

See Fig. 4.

Fig. 4
figure 4

Survival curve by age group, adult versus pediatric. Adults are ≥18 years old. Product-limit survival estimates, with 95 % Hall–Wellner bands. Right censored at 30 days

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Ttendo, S.S., Was, A., Preston, M.A. et al. Retrospective Descriptive Study of an Intensive Care Unit at a Ugandan Regional Referral Hospital. World J Surg 40, 2847–2856 (2016). https://doi.org/10.1007/s00268-016-3644-5

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