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Critically ill patients in Malawi often did not get essential treatments like oxygen during Covid-19

Lay summary of the article published under the DOI: 10.1371/journal.pone.0256361

Published onFeb 07, 2023
Critically ill patients in Malawi often did not get essential treatments like oxygen during Covid-19

Researchers say that during the Covid-19 pandemic, critically ill patients in two big hospitals in Malawi often didn’t receive basic essential medical attention, and some died in hospital as a result.  Many lives can be saved, especially during disease outbreaks such as Covid-19, if patients receive the necessary treatments.

Hospitals receive critically ill patients everyday, and the situation was worsened due to the outbreak of Covid-19. Most critical patients have difficulty breathing, low blood pressure and some are unconscious. Hospitals should be able to correctly assess these patients because it is fairly easy and cheap to do, and it helps doctors give the correct treatment. 

Unfortunately, it is still not clear how many hospitals are actually able to do this in developing countries.

In this study, the researchers wanted to know how many critically ill adult patients in Malawi were correctly identified and given the right treatment.

They studied 2 hospitals in Malawi, looking at patients aged above 18 who had difficulty breathing, low blood pressure or were unconscious. They wanted to see if patients who had difficulty breathing received breathing air (oxygen), if those with low blood pressure received ‘fluid drips’, or if those who were unconscious were laid down properly.

The researchers found out that of the 1135 patients they checked, 4.0% had difficulty breathing, 9.1% had low blood pressure, and 1.5% were unconscious. They said 88.9% of those who had difficulty in breathing did not get breathing air (oxygen), 91.3% of those with low blood pressure did not get drips, and 53% of those who were not unconscious were not laid down properly to help them breathe.

The researchers also reported that 22% of those who had difficulty breathing, 22% of those with low blood pressure, and 53% of those who were unconscious died within a week while in hospital. 

These results suggest that more must be done in these hospitals to provide relevant treatment to critically ill patients with Covid-19 or other diseases, as many lives could be saved without the need for expensive hospital equipment.

The researchers however cautioned against drawing broader conclusions based on their study, since they only looked at patients from 2 hospitals and only collected data for 5 days.

They also said the treatments they looked for in this study do not always save the lives of patients, so they may have overestimated the need for such treatments.

The researchers recommended more studies to understand why critical patients often do not get essential treatments, and how hospitals might use more of these cost-effective measures to save lives.


This summary is a free resource intended to make African research and research that affects Africa, more accessible to non-expert global audiences. It was compiled by ScienceLink's team of professional African science communicators as part of the Masakhane MT: Decolonise Science project. ScienceLink has taken every precaution possible during the writing, editing, and fact-checking process to ensure that this summary is easy to read and understand, while accurately reporting on the facts presented in the original research paper. Note, however, that this summary has not been fact-checked or approved by the authors of the original research paper, so this summary should be used as a secondary resource. Therefore, before using, citing or republishing this summary, please verify the information presented with the original authors of the research paper, or email [email protected] for more information.

A Reply to this Pub
Unmet need of essential treatments for critical illness in Malawi

Background Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. Methods We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). Results Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). Conclusion There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.

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