Current global health efforts to decrease mortality neglect improving the management of severely ill hospitalized patients.
Severe illness represents a major burden of disease. In low-income countries, ~80% of deaths could potentially benefit from improved management of severely ill patients. Yet, much of the focus of global health programs is currently on preventing disease or preventing the progression of disease. For instance, the global response to HIV, particularly in sub-Saharan Africa, has focused on supporting prevention campaigns and HIV treatment with anti-retroviral therapy. While important gains have been achieved through this strategy, the number of deaths annually in people aged 15-45 from HIV continues to be upwards of 2 million per year—a veritable global health blind spot. All of these deaths occurred after a severe manifestation of illness and strong evidence suggests that improving care in hospital settings can both reduce mortality and cost less in the process., Thus, quality of care for severely-ill hospitalized patients deserves to be prioritized in global health.
There is a strong need to improve management of severe illness in Uganda.
Severely ill patients have poor outcomes, and many die of conditions for which early supportive care interventions are associated with favorable outcomes. In Uganda where the HIV prevalence is currently 7.2% among young individuals, mortality from severe illness due to opportunistic infections continues to be high with over 60,000 individuals dying of HIV in 2012. Our work at Mulago Hospital has shown that >80% of patients hospitalized with sepsis and pneumonia are HIV-infected, and mortality is extra-ordinarily high with at least 1 in 3 severely ill patients succumbing to their acute condition. Importantly, our group has also demonstrated among these severely ill patients that inexpensive and feasible interventions can deter death--our study of early, monitored fluid resuscitation for sepsis patients at Mulago Hospital demonstrated a decrease in mortality from 46% to 33%.
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