Critical Care Units in Malawi: A Cross-Sectional Study

Background: The global burden of critical illness falls disproportionately outside high-income countries. Despite younger patient populations with similar or lower disease severity, critical illness outcomes are poor outside high-income countries. A lack of data limits attempts to understand and address the drivers of critical care outcomes outside high-income countries. Objectives: We aim to characterize the organization, available resources, and service capacity of public sector critical care units in Malawi and identify barriers to improving care. Methods: We conducted a secondary analysis of the Malawi Emergency and Critical Care Survey, a cross-sectional study performed from January to February 2020 at all four central hospitals and a simple random sample of nine out of 24 public sector district hospitals in Malawi, a predominantly rural, low-income country of 19.6 million in southern Africa. Data from critical care units were used to characterize resources, processes, and barriers to care. Findings: There were four HDUs and four ICUs across the 13 hospitals in the Malawi Emergency and Critical Care Survey sample. The median critical care beds per 1,000,000 catchment was 1.4 (IQR: 0.9 to 6.7). Absent equipment was the most common barrier in HDUs (46% [95% CI: 32% to 60%]). Stockouts was the most common barriers in ICUs (48% [CI: 38% to 58%]). ICUs had a median 3.0 (range: 2 to 8) functional ventilators per unit and reported an ability to perform several quality mechanical ventilation interventions. Conclusions: Although significant gaps exist, Malawian critical care units report the ability to perform several complex clinical processes. Our results highlight regional inequalities in access to care and support the use of process-oriented questions to assess critical care capacity. Future efforts should focus on basic critical care capacity outside of urban areas and quantify the impact of context-specific variables on critical care mortality

Dataset in support of the Southampton doctoral thesis : Understanding social capital and the role it plays in food security in Malawi

Qualitative fieldwork notes from focus group discussions (FGDs) in support of Chapter 5 of doctoral thesis &quot;Bonding, bridging and linking social capital combinations for food access; A gendered case study exploring temporal differences in Southern Malawi.&quot; This research paper has been submitted to the Journal of Rural Studies.The FGDs were conducted with a seasonal calendar at the start, FGD and ranking exercise at the end (available in this data notes). The research themes in this data were conducted based on questions around food security, social capital, temporal changes, gender and weather, to explore how social capital typologies are used to access food. </span

Additional file 1 of Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study

Additional file 1: Table S1. Wards Reporting Adequate Ability to Perform Key Critical Care Signal Functions