The Pattern of Admission, Clinical Characteristics, and Outcomes Among Patients Admitted to the Intensive Care Unit of a Tertiary Hospital in Tanzania: A 5-Year Retrospective Review

Abstract

Introduction

Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.

Material and Methods

A single-center retrospective study that reviewed records of all medically admitted patients admitted to the ICU of the Aga Khan Hospital, Dar-es-Salaam, from 1st October 2018 to 30th April 2023. To define the population in the study, we used descriptive statistics. Patients’ outcomes were categorized based on ICU survival. Binary logistic regression was run (at 95% CI and p-value < 0.05) to identify the determinants for ICU mortality.

Results

Medical records of 717 patients were reviewed. The cohort was male (n=472,65.8%) and African predominant (n=471,65.7%) with a median age of 58 years (IQR 45.0–71.0). 17.9% of patients did not survive. The highest mortality was noted amongst patients with septic shock (29.3%). The lowest survival was noted amongst patients requiring three organ support (n=12,2.1%). Advanced age (OR 1.02,CI 1.00–1.04), having more than three underlying comorbidities (OR 2.50,CI 1.96–6.60), use of inotropic support (OR 3.58,CI 1.89–6.80) and mechanical ventilation (OR 9.11,CI 4.72–18.11) showed association with increased risk for mortality in ICU.

Conclusion

The study indicated a much lower ICU mortality rate compared to similar studies conducted in other parts of Sub-Saharan Africa. Advanced age, underlying multiple comorbidities and organ support were associated with ICU mortality. Large multi-center studies are needed to highlight the true burden of critical care illness in Tanzania.

Keywords:

• critical care
• Tanzania
• mortality
• epidemiological profile

Data Sharing Statement

The data set can be made available upon request from the corresponding author.

Ethical Approval

The study was approved by the Aga Khan University, East Africa Ethical Research Committee (AKU, EA ERC). The National Institute for Medical Research (NIMR) in Tanzania mandates the AKU, EA ERC to approve health research conducted by Tanzanian students. The hospital’s ethical committee and the AKU, EA, ERC exempted the primary investigator from acquiring informed consents from the study participants, since the study design did not affect the rights and welfare of the patients. This study was conducted in accordance with the Declaration of Helsinki. Reference (AKU/2023/012/fb/09/013).

Acknowledgment

We would like to thank the emergency department and the Intensive Care Unit (ICU) of the Aga Khan Hospital, Dar-es- Salaam, Tanzania.

Disclosure

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.