Diagnoses and outcomes of critically ill patients admitted to a high dependency unit of a rural referral hospital in Tanzania: A prospective cohort study.

Authors

  • Christamonica Chitimbwa St. Francis Regional Referral Hospital
  • Martin Rohacek St. Francis Referral Hospital, Ifakara, Tanzania Swiss Tropical and Public Health Institute, Allschwil, Switzerland Assistant Professor University of Basel, Switzerland,Ifakara Health Institute
  • Weisser Rohacek Maja CDCI, IHI, ST. FRANCIS REFFERAL HOSPITAL
  • Thomas Zoller
  • Andrew Katende IHI, ST. FRANCIS REFFERAL HOSPITAL

Keywords:

High dependency unit, Critical care, Rular Africa, Outcome, Diagnoses, Mortality

Abstract

Background: Evidence on outcomes of patients admitted to high dependency units (HDUs) of hospitals situated in rural sub-Saharan Africa remains highly limited. In this study, we describe patient’s characteristics, diagnoses, and outcomes of critically ill patients admitted to a high dependency unit of a referral hospital in rural Tanzania, and factors associated with in-hospital mortality.

Methods: This prospective single-center cohort study was conducted in the HDU of a rural referral hospital in Tanzania. All patients admitted to the HDU within routine care were eligible. We performed descriptive analyses, univariate- and multivariate models and the area under the receiver operating characteristic curve for predictors of in-hospital mortality.

Results: From April 4th 2023 to March 29th 2024, 491 admitted patients were included and followed-up until hospital discharge. Median patients’ age was 46 years (IQR 29-65); 259 (53%) were females. The most common diagnoses were sepsis (N=96, 20%), hypertension (N=91, 19%), diabetes mellitus (N=84, 17%) acute kidney injury (N=66, 13%), decompensated heart failure (N=64, 13%), aspiration pneumonia (N=60, 12%), and stroke (n=59, 12%). Mortality during HDU and hospital stay was 30% and 37%, respectively. Predictors of in-hospital mortality were age ³ 45 years (adjusted Hazard Ratio (aHR) 1.56, 95%CI 1.07-2.28, p=0.03), blood pressure <90mmHg (aHR 2.33, 95%CI 1.48-3.81, p<0.001), Glasgow Coma Scale score  £ 8 (aHR 2.13, 95%CI 1.24-3.64, p=0.02) and oxygen saturation at room air < 90% (aHR 1.62, 95% CI 1.04-2.51, p=0.03). The area under the curve predicting in-hospital mortality was 0.69 (95%CI 0.65-0.73) for the NEWS score, 0.69 (95%CI 0.65-0.73) for the UVA score, 0.66 (95%CI 0.62-0.70) for the MEWS score, 0.65 (95%CI 0.61-0.69) for the qSOFA score, and 0.52 (95% CI 0.49-0.55) for the SIRS score.

Conclusion: Sepsis and non-communicable diseases were the most common diagnoses. Mortality was high, with scores predicting in-hospital mortality with a moderate accuracy.

 

 

 

 

Author Biography

Martin Rohacek, St. Francis Referral Hospital, Ifakara, Tanzania Swiss Tropical and Public Health Institute, Allschwil, Switzerland Assistant Professor University of Basel, Switzerland,Ifakara Health Institute

PD Dr. Martin Rohacek, MD

Physician, Project Leader Emergency Medicine, Heart and Lung Clinic and Intermediate Care

Published

2026-04-26

Issue

Vol. 2 No. 1 (2025)

Section

Articles