Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement

PURPOSE

Intensive care units (ICUs) in low- and middle-income countries have high mortality rates, and clinical data are needed to guide quality improvement (QI) efforts. This study utilizes data from a validated ICU registry specially developed for resource-limited settings to identify evidence-based QI priorities for ICUs in Ethiopia.

MATERIALS AND METHODS

A retrospective cohort analysis of data from two tertiary referral hospital ICUs in Addis Ababa, Ethiopia from July 2021-June 2022 was conducted to describe casemix, complications and outcomes and identify features associated with ICU mortality.

RESULTS

Among 496 patients, ICU mortality was 35.3%. The most common reasons for ICU admission were respiratory failure (24.0%), major head injury (17.5%) and sepsis/septic shock (13.3%). Complications occurred in 41.0% of patients. ICU mortality was higher among patients with respiratory failure (46.2%), sepsis (66.7%) and vasopressor requirements (70.5%), those admitted from the hospital ward (64.7%), and those experiencing major complications in the ICU (62.3%).

CONCLUSIONS

In this study, ICU mortality was high, and complications were common and associated with increased mortality. ICU registries are invaluable tools to understand local casemix and clinical outcomes, especially in resource-limited settings. These findings provide a foundation for QI efforts and a baseline to evaluate their impact.

An HPLC-FLD method to measure ochratoxin A in teff (Eragrostis tef) and wheat (Triticum spp.) destined for the local Ethiopian market

Wheat (Triticum spp.) is among the top cereal grains in terms of production and consumption in Ethiopia. It can be typically infected with ochratoxin A (OTA) producing fungi both in the field and during storage resulting in animal and human health problems. While there is a wealth of information on the presence of OTA in wheat, the incidence of OTA in teff (Eragrostis tef), a cereal grain produced and consumed traditionally in Ethiopia and Eretria, remains insufficient. The purpose of this study was to develop and validate a high performance liquid chromatography (HPLC) method for OTA analysis in teff and wheat flours and to analyse the characteristic distribution of OTA in teff and wheat flours samples destined for local consumption in Ethiopia using a survey-approach. Wheat and teff flour samples were examined for OTA contamination. OTA was detected in 20% of the teff flour samples and in 50% of the wheat flour samples with median contamination levels of 1.04 μg/kg (limit of detection (LOD) = 0.78 μg/kg) and 7.23 μg/kg (LOD = 0.58 μg/kg) respectively. The validated method for OTA detection and quantification in teff and wheat using HPLC meets the European Union performance criteria for OTA (EC 2006/401) and the Eurachem Guideline validation requirements. An insight into the occurrence of OTA in teff is very valuable because the cereal might provide a lower OTA risk alternative for wheat in Ethiopia. In addition, for the world market, an insight into the occurrence of OTA in teff is important in the light of an increasing interest in teff as a gluten free cereal.