title: Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania.
abstract: BACKGROUND
  In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania.
  
  
  METHODS
  This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC).
  
  
  RESULTS
  MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009-2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%.
  
  
  CONCLUSIONS
  The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care to critically ill patients and likely contributing to the dauntingly high mortality rates.
authors.affiliation: Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania. hendry.sawe@mnh.or.tz.
authors.forename: Hendry R
authors.initials: HR
authors.lastname: Sawe
authors.forename: Juma A
authors.initials: JA
authors.lastname: Mfinanga
authors.forename: Salum J
authors.initials: SJ
authors.lastname: Lidenge
authors.forename: Boniventura C T
authors.initials: BC
authors.lastname: Mpondo
authors.forename: Silas
authors.initials: S
authors.lastname: Msangi
authors.forename: Edwin
authors.initials: E
authors.lastname: Lugazia
authors.forename: Victor
authors.initials: V
authors.lastname: Mwafongo
authors.forename: Michael S
authors.initials: MS
authors.lastname: Runyon
authors.forename: Teri A
authors.initials: TA
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000592:standards; D016638:Critical Illness; D006295:Health Resources; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007239:Infections / Q000628:therapy; D007362:Intensive Care Units / Q000592:standards; D007902:Length of Stay; D008875:Middle Aged; D010343:Patient Admission; D011014:Pneumonia / Q000628:therapy; D012017:Referral and Consultation; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000592:standards; D013742:Tetanus / Q000628:therapy; D014947:Wounds and Injuries / Q000628:therapy; D055815:Young Adult