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Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review.
Kazibwe, Joseph; Shah, Hiral A; Kuwawenaruwa, August; Schell, Carl Otto; Khalid, Karima; Tran, Phuong Bich; Ghosh, Srobana; Baker, Tim; Guinness, Lorna.
  • Kazibwe J; Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK Joseph.Kazibwe@lshtm.ac.uk.
  • Shah HA; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  • Kuwawenaruwa A; Center for Global Development, Washington, DC, USA.
  • Schell CO; Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania.
  • Khalid K; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
  • Tran PB; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
  • Ghosh S; Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
  • Baker T; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
  • Guinness L; Global Health Department, Center for Global Development, Washington, DC, USA.
BMJ Open ; 12(11): e060422, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2137703
ABSTRACT

OBJECTIVES:

Critical care is essential in saving lives of critically ill patients, however, provision of critical care across lower resource settings can be costly, fragmented and heterogenous. Despite the urgent need to scale up the provision of critical care, little is known about its availability and cost. Here, we aim to systematically review and identify reported resource use, availability and costs for the provision of critical care and the nature of critical care provision in Tanzania.

DESIGN:

This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Medline, Embase and Global Health databases were searched covering the period 2010 to 17 November 2020. ELIGIBILITY CRITERIA We included studies that reported on forms of critical care offered, critical care services offered and/or costs and resources used in the provision of care in Tanzania published from 2010. DATA EXTRACTION AND

SYNTHESIS:

Quality assessment of the articles and data extraction was done by two independent researchers. The Reference Case for Estimating the Costs of Global Health Services and Interventions was used to assess quality of included studies. A narrative synthesis of extracted data was conducted. Costs were adjusted and reported in 2019 US$ and TZS using the World Bank GDP deflators.

RESULTS:

A total 31 studies were found to fulfil the inclusion and exclusion criteria. Critical care identified in Tanzania was categorised into intensive care unit (ICU) delivered critical care and non-ICU critical care. The availability of ICU delivered critical care was limited to urban settings whereas non-ICU critical care was found in rural and urban settings. Paediatric critical care equipment was more scarce than equipment for adults. 15 studies reported on the costs of services related to critical care yet no study reported an average or unit cost of critical care. Costs of medication, equipment (eg, oxygen, personal protective equipment), services and human resources were identified as inputs to specific critical care services in Tanzania.

CONCLUSION:

There is limited evidence on the resource use, availability and costs of critical care in Tanzania. There is a strong need for further empirical research on critical care resources availability, utilisation and costs across specialties and hospitals of different level in low/middle-income countries like Tanzania to inform planning, priority setting and budgeting for critical care services. PROSPERO REGISTRATION NUMBER CRD42020221923.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Care / Intensive Care Units Type of study: Reviews / Systematic review/Meta Analysis Limits: Adult / Child / Humans Country/Region as subject: Africa Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-060422

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Care / Intensive Care Units Type of study: Reviews / Systematic review/Meta Analysis Limits: Adult / Child / Humans Country/Region as subject: Africa Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-060422