title: Critical Care in a Tertiary Hospital in Malawi.
abstract: The provision of critical care services is essential to healthcare systems and increasingly a global health focus, but many hospitals in sub-Saharan Africa are unable to meet this need. Intensive care unit (ICU) mortality in this region is high, but studies describing the provision of critical care services are scarce.
  
  
  
  This was a retrospective cohort study of all patients admitted to the ICU at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, between September 1, 2013, and October 17, 2014. We summarized demographics, clinical characteristics, and outcomes, and analyzed factors associated with mortality.
  
  
  
  Of 390 patients admitted to ICU during the study, 44.9 % of patients were male, and the median age was 22 years (IQR 6-35) years. Although most patients (73.1 %) were admitted with surgical diagnoses, the highest mortality was among patients admitted with sepsis (59.3 %), or obstetric (44.7 %) or medical (40.0 %) diagnoses. Overall ICU mortality was high (23.6 %).
  
  
  
  There is a shortage of data describing critical care in low-resource settings, particularly in sub-Saharan Africa. Surgical disease comprises the majority of ICU utilization in this study site, but medical and obstetric illness carried higher ICU mortality. These data may guide strategies for improving critical care in the region.
authors.affiliation: Department of Anesthesiology & Critical Care, Columbia University College of Physicians & Surgeons, New York, NY, 10032, USA. mep9042@nyp.org.
authors.forename: Meghan
authors.initials: M
authors.lastname: Prin
authors.affiliation: College of Medicine, University of Malawi, Mahatma Gandhi Rd, Chichiri, Private Bag 360, Blantyre 3, Malawi.
authors.forename: Takondwa
authors.initials: T
authors.lastname: Itaye
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, 251 E. Huron Street, F5-704, Chicago, IL, 60611, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Clark
authors.affiliation: Department of Anesthesiology & Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: Rohesh J
authors.initials: RJ
authors.lastname: Fernando
authors.affiliation: College of Medicine, University of Malawi, Mahatma Gandhi Rd, Chichiri, Private Bag 360, Blantyre 3, Malawi.
authors.forename: Felix
authors.initials: F
authors.lastname: Namboya
authors.affiliation: College of Medicine, University of Malawi, Mahatma Gandhi Rd, Chichiri, Private Bag 360, Blantyre 3, Malawi.
authors.forename: Gregor
authors.initials: G
authors.lastname: Pollach
authors.affiliation: College of Medicine, University of Malawi, Mahatma Gandhi Rd, Chichiri, Private Bag 360, Blantyre 3, Malawi.
authors.forename: Nyengo
authors.initials: N
authors.lastname: Mkandawire
authors.affiliation: Department of Anesthesiology & Critical Care, Columbia University College of Physicians & Surgeons, New York, NY, 10032, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Sobol
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008295:Malawi; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D055815:Young Adult