Hospital patients in Africa who are critically ill with Covid-19 are far more likely to die than in other parts of the world, a study suggests.
A shortage of critical care resources was a key problem, it says.
This includes both a lack of specialised staff and equipment such as blood oxygen monitors.
The researchers hope their work will help inform the way severely ill patients are managed where resources are limited.
Despite the high mortality rates of Covid-19 patients who have ended up in hospital in Africa, the continent in general has recorded some of the lowest numbers of deaths from the virus.
Africa, which has 17% of the world’s population, accounts for 4% of registered Covid-19 deaths.
Researchers looked at more than 3,000 patients in 64 hospitals across 10 African countries for the study published in the The Lancet medical journal.
They found that nearly half who needed intensive care died whereas the global average was less than a third.
The authors provide some insights into possible causes, such as a shortage of critical care resources and underuse of those that are available.
For example 68% of hospitals had access to dialysis but only 10% of the patients received it.
Poor maintenance of equipment and lack of skilled human labour to operate such equipment was also a problem.
In 2017, the Tropical Health and Education Trust reported that 40% of the medical equipment in Africa was out of service, 80% of the medical equipment was donated, 70–90% of the donated equipment was never operationalised.
Highly transmissible variants of SARS-CoV-2, including B.1.1.7 initially identified in England in September, 2020; P.1, circulating in Brazil since the middle of 2020; and B.1.351, which was first detected in South Africa in late 2020, could directly be related to high COVID-19-related mortality.
The capacity to detect variants in Africa is limited because of inadequate skill and infrastructure for genomic sequencing.
Lack of vaccination has also increased the number of critically ill Covid-19 patients.