Evidence map›Paper›PMID 37798681›Full record

ArticleBMC health services research2023

Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study.

Emilia Connolly, Noel Kasomekera, Paul D Sonenthal, Mulinda Nyirenda, Regan H Marsh, Emily B Wroe, Kirstin W Scott, Alice Bukhman, Tadala Minyaliwa, Martha Katete and 3 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.3field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Review
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  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 2 countries.

Emilia Connolly, Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi. econnolly@pih.org.
Noel Kasomekera, Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi.
Paul D SonenthalPartners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA.
Mulinda NyirendaAdult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi.
Regan H MarshPartners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA.
Emily B WroePartners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA.
Kirstin W ScottDepartment of Emergency Medicine, University of Washington, Seattle, USA.
Alice BukhmanHarvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
Tadala Minyaliwa, Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi.
Martha Katete, Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi.
Grace BandaAdult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi.
Joia MukherjeePartners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA.
Shada A RouhaniPartners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA.
Public Health Institute of Malawi · MWHarvard University · USLemuel Shattuck Hospital · USQueen Elizabeth Central Hospital · MWUniversity of Washington · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAs low-income countries (LICs) shoulder a disproportionate share of the world's burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes.

methodsThis was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher's exact test.

resultsFrom the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant.

conclusionDespite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study.

Indexed as

Patient Care BundlesCritical CareCritical IllnessCross-Sectional StudiesHospitalsHumansIntensive Care UnitsMalawiBarriersCare capacityCritical careMedical ward

Identifiers

PMID37798681
PMCPMC10557270
OpenAlexW4387364890

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.