Abstract:
Rationale:
Despite the disproportionate burden of critical illness in low- and middle-income countries
(LMICs), access to intensive care units (ICUs) remains limited. At Moi Teaching and Referral
Hospital (MTRH), a public referral hospital in Western Kenya serving over 24 million people,
critically ill patients are often managed in general wards without close monitoring due to
insufficient ICU space. While qualitative evidence suggests a significant need for increased ICU
capacity, the actual demand is unknown.
Methods:
This mixed-methods study quantified the prevalence of critical illness, defined as a National
Early Warning Score (NEWS) greater than six, among adults presenting and admitted to MTRH
between November 2024 and June 2025. Participants were enrolled from the emergency
department and all general wards during three separate 24-hour periods. Adults with NEWS >
six were followed for outcome, ICU admission, and subsequent NEWS at 7, 14, 21, and 28
days. Key informant interviews with healthcare providers directly involved in the care of critically
ill patients explored workflows, perceptions of critical illness, and barriers to ICU expansion.
Results:
Of 1,274 patients enrolled, 187 (14.7%) had a NEWS > six. Six (3.2%) were admitted to an ICU
and 33 (17.6%) died by day 28. Most critically ill patients were identified in the internal medicine
wards (50.3%), general surgery wards (15.5%), and emergency department (12.3%).
Preliminary qualitative findings among 6 key informants suggest nursing and bed shortages are
the primary barriers to ICU transfer. Other factors include reliance on ambulance transport,
proximity of the ICU, dialysis, and imaging facilities, and the absence of standardized protocols
for critical illness assessment and transfer
