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The African Critical Illness Outcomes Study (ACIOS): a point prevalence study of critical illness in 22 nations in Africa

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The African Critical Illness Outcome Study (ACIOS) is the largest study to date on critical illness in Africa, highlighting a significant burden of life-threatening conditions in hospitals across the continent. The study aimed to assess the prevalence, management, and outcomes of critically ill patients while identifying gaps in essential emergency and critical care (EECC).

Associate Professor Arthur Kwizera (College of Health Sciences, Makerere University) was a Co-Investigator and National Lead for Uganda in partnership with researchers from Europe and Africa.

A Research publication detailing the study was published in the Lancet and can be downloaded here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02846-0/fulltext

Key Findings

  • High Prevalence of Critical Illness: One in eight hospital inpatients (12.5%) in Africa are critically ill.
  • High Mortality Rate: Critically ill patients face a 21% seven-day mortality rate, significantly higher than the 2.7% mortality for non-critically ill patients.
  • Limited Access to Intensive Care: Nearly 70% of critically ill patients receive care in general hospital wards rather than intensive care units (ICUs) or high-dependency units.
  • Insufficient Emergency Care: Over 56% of critically ill patients do not receive essential emergency and critical care (EECC), including oxygen therapy, intravenous fluids, and airway management.

Significance
The study provides first-of-its-kind epidemiological data on critical illness across multiple African countries. The findings highlight severe gaps in emergency care infrastructure and resources, emphasizing the need for investment in low-cost, lifesaving interventions to reduce mortality. Addressing these gaps through EECC can save many lives without requiring high-cost ICU infrastructure.

Study Methodology
ACIOS was a multi-country prospective study, involving 20,000 patients from 180 hospitals in 22 African countries. Investigators assessed all adult inpatients (≥18 years) across different hospitals, identifying those with severely deranged vital signs. Patients were then followed up over seven days to determine their health outcomes. Additionally, the study collected hospital resource availability data to assess the readiness of facilities to provide critical care.

Funding and Collaboration
The study was funded by the National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850) with Professors Rupert Pearse and Bruce Biccard as PIs, and conducted in partnership with Makerere University (Uganda) led by Associate Professor Arthur Kwizera (as Co-PI and national lead), Busitema University (Uganda) led by Dr Adam Hewitt Smith, University of Cape Town (South Africa) led by Bruce Biccard, Muhimbili University of Health and Allied Sciences (Tanzania) Led by Dr Tim Baker, Queen Mary University of London (UK), the African Perioperative Research Group, and the EECC Network.

Policy Implications
The findings call for urgent action by health policymakers and hospital administrators to:

  • Strengthen emergency and critical care services in general hospital wards.
  • Improve the availability of essential life-saving interventions such as oxygen therapy and IV fluids.
  • Train healthcare workers in essential emergency and critical care (EECC) protocols to enhance patient outcomes.

Relevance to Uganda
Uganda, like many African countries, faces a severe shortage of ICU beds and critical care services. The study underscores the urgent need for investment in critical care infrastructure and workforce training to improve survival rates among critically ill patients.

Conclusion
The ACIOS study is a wake-up call for Africa’s healthcare systems, urging greater focus on low-cost, high-impact interventions that can significantly reduce mortality among critically ill patients. By prioritizing essential emergency and critical care, health systems can improve survival rates without requiring large investments in ICU infrastructure.

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PhD Fellowship Opportunity: NETOMA Study

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Dr. Henry Komakech (centre) stands with fellow MakSPH PhD graduands at Makerere University’s 76th Graduation Ceremony (L–R): Dr. Olivia Nakisita, Dr. Aber Harriet Odonga, Dr. David Lubogo, Dr. Samalie Namukose, Dr. Moses Ntaro and Dr. Jimmy Osuret. February 25, 2026, Freedom Square, Makerere University. Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Henry Komakech, “Effects of the Repatriation of Refugees on the Health Services of the Host Populations in the West Nile Districts of Arua, Moyo, and Adjumani,” Kampala Uganda, East Africa.

Makerere University School of Public Health invites applications for a PhD fellowship under the Wellcome Trust-supported NETOMA study, which examines the coexistence of health worker shortages and unemployment among qualified health professionals in Africa.

The successful candidate will undertake doctoral research involving ethnographic fieldwork and qualitative analysis of health workers’ professional identities, employment experiences and livelihoods. Applicants should hold a Master’s degree in Anthropology, Sociology, Development Studies, Political Economy or a closely related discipline, with training in qualitative research methods.

Application deadline: 21 October 2026

Full details and application instructions: https://sph.mak.ac.ug/careers/?view_job=21462

Mak Editor

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Makerere-Mulago Host Oncology Specialist – Professor Dr. Thiha AUNG

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Professor Dr. Thiha AUNG during his interview with the Public Relations Office on 7th October 2026. Public Relations Office interview with Professor Dr. Thiha AUNG, German oncology reconstruction specialist, surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany. 7th October 2026, Main Building, Makerere University, Kampala Uganda, East Africa.

Through a European Union (EU) funded initiative, Makerere University and Mulago Hospital are hosting a German oncology reconstruction specialist Professor Dr. Thiha AUNG. AUNG is a surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany.

With his international expertise in oncology and medical management roles at his home institution, his visit is a valuable addition to Uganda’s capacity building efforts in medical advancement.

Prof. Aung who arrived in Uganda in late September 2026 and has since then conducted free identified patient specialised surgeries and training for locals. These are expected to span two weeks. For the period, his service intersects medical expertise and humanitarian efforts.

This is not Prof. Aung’s first time in the country; his first major visit was in 2023, when he performed life-changing free surgeries on early patients. He then made medical history in June 2024 when he arrived to perform Africa’s first-ever lymph node transplant at Mulago Hospital.

It was against this background that the Makerere Public Relations Office engaged him in an exclusive interview to share his philosophy on medical service, his experiences in oncology reconstruction, and his unwavering belief that passion and dedication rather than just resources are the true drivers of sustainable medical progress.

Transforming Lives Through Oncology Reconstruction

At the heart of his mission through the ERASMUS – Oncology/Lymphedema project, is the treatment of lymphedema, a condition often referred to as elephantiasis.

In Europe, such surgeries can cost between 80,000 and 100,000 euros, making them inaccessible to many.

Thankfully, Professor and his team, including some of his post graduate students like Anna Friedrich (B.Sc) and Sophia Waser (B.Sc., PA) from the Institute of Medical Science and Engineering, have once again brought this specialised care to Uganda pro bono.

Professor AUNG with the article author. Public Relations Office interview with Professor Dr. Thiha AUNG, German oncology reconstruction specialist, surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany. 7th October 2026, Main Building, Makerere University, Kampala Uganda, East Africa.
Professor AUNG with the article author.

He highlights the story of a teacher who, after receiving surgery, regained her quality of life and returned to the classroom. For him, the impact is exponential. “You change one life, but this person changes a lot in the community.”

This shift from individual surgery to the long-term wellbeing of the community, reinforces the local impact of these services.

Professor AUNG’s Personal Conviction

The professor confessed that inherently, he commands himself that beyond knowledge, true progress is driven by passion and will rather than resources.

He does not agree with those that think money and resources are the sole prerequisite for change in the medical world, stating, “you cannot change with money only.” Rather, he upholds the importance of personal decision and commitment.

When discussing the challenges of working in resource-limited settings, he maintains a simple, direct explanation “it’s always beyond the money.”

Ultimately, the Professor believes that if he can provide the spark, his students and patients can carry through with the same flame for significant change.

Motivation to Serve in Uganda

When asked about his inspiration for entering the field and now volunteering to work in Uganda, he explained that his primary goal was always to serve others. “That’s why I finished my medical school to help as many people as possible with my skills.”

Professor AUNG gestures during the interview. Public Relations Office interview with Professor Dr. Thiha AUNG, German oncology reconstruction specialist, surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany. 7th October 2026, Main Building, Makerere University, Kampala Uganda, East Africa.
Professor AUNG gestures during the interview.

He views his medical expertise not as a tool for the privileged, but as a universal resource., “People are all the same, their anatomy is the same. So, I can help all these people pretty well,” Prof AUNG remarked.

His approach is motivated by a pay it forward dogma where treating a single patient creates a broader societal benefit. He illustrates this through his work with patients who, after surgery, are able to return to their professions like the teacher earlier mentioned.

Tips for Medical Professionals working in Uganda

As a foundation for professional growth, the Professor advised medical professionals working in Uganda to prioritise genuine interest in their work because he believes it is “the most important…” for “if you are interested, you will go far in the profession.”

He further reinforced the human capacity point, noting, “no matter what kind of equipment you have… it all depends on the people operating them and the patient.”

Professor AUNG concluded by encouraging doctors to overcome resource fears through action, stating, “If you want to create impact or change, you do.”

Dr. AUNG is part of the Lymphoedema Warriors Association (LWAU) in Uganda. He describes it as a grassroots organisation and commends them for “leveling the grond”. He reiterated his commitment to work with the organisation in reviewing patient reports to determine the best course of treatment.

Elvis Lubanga, Makerere University, Kampala Uganda, East Africa.
Elvis Lubanga

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Makerere Public Health Showcases EU Funded Research

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Makerere University’s School of Public Health (MakSPH) showcased research, training and international partnerships supported through European Union funding during the EU Uganda Research and Study Fair 2026 held at Makerere University.

The fair brought together students, researchers, academics, government representatives and development partners to explore opportunities in education, research, innovation and international collaboration, while celebrating 50 years of partnership between Uganda and the European Union.

Through its exhibition, MakSPH highlighted research and capacity building initiatives addressing public health challenges including infectious diseases, non communicable diseases, health systems, climate change and pandemic preparedness.

18 EU funded projects supported at MakSPH

Prof. Rhoda Wanyenze, Dean of Students, School of Public Health, said the School has benefited from 18 EU funded projects over the past five years, supporting research and training across several areas of public health.

Prof. Rhoda Wanyenze explains MakSPH research projects to Acting Minister of Education and Sports Dr John Chrysostom Muyingo during a tour of exhibition stands at the EU Uganda Research and Study Fair.

She said the projects have contributed to the training of PhD researchers and the development of research addressing infectious diseases and prevention, non communicable diseases, health systems, climate change and health.

Prof. Wanyenze also highlighted a new five year programme which started in 2021 that is aiming at strengthening capacity for research on pandemic preparedness and response, including outbreaks such as Ebola.

Stella Kakeeto interacts with students during the EU Uganda Research and Study Fair

Another programme being undertaken with the Ministry of Health and Karolinska Institute focuses on improving maternal health while also addressing adolescent pregnancy and the health of mothers and children.

She described partnerships as critical to advancing science and innovation, noting that collaboration allows researchers in Africa and Europe to share knowledge and strengthen the impact of research on communities.

Research partnerships strengthen innovation

Prof. Robert Wamala, Director of the Directorate of Research, Innovation and Partnerships at Makerere University, said the exhibition provided an opportunity to showcase EU funded projects across the University.

He noted that the School of Public Health alone has more than 18 such projects, while other colleges also have several EU supported initiatives.

Prof. Julius Okuni

One of the projects showcased was PREPARE TID, a partnership aimed at developing rapid diagnostic technologies for emerging and re emerging infectious diseases.

Prof. Julius Okuni, Associate Professor of Veterinary Pathobiology and Molecular Diagnostics at Makerere University, said the project brings together universities, industries and other organisations from Africa and Europe.

The project is working to develop technologies that can quickly identify pathogens responsible for outbreaks such as Ebola, Rift Valley fever and Crimean Congo haemorrhagic fever.

According to Prof. Okuni, Makerere is involved in field and laboratory work to test and refine the technologies before they can be delivered to end users.

Fair provides platform for research visibility

For researchers at MakSPH, the fair also provided an opportunity to increase the visibility of ongoing research and create new connections with researchers, policymakers and potential funders.

Dr. Raymond Tweheyo, Honorary Lecturer and Senior Research Fellow in the Department of Health Policy, Planning and Management, said such exhibitions allow researchers to share their work and identify others working on related challenges.

Dr. Raymond Tweheyo and Assoc. Prof. Angelina Kakooza Mwesigye at the exhibition

He cited the CONNECT for Health project, which focuses on transforming non-communicable disease care in Uganda through collaboration with partners across several countries.

Dr. Tweheyo said exhibitions can help researchers connect with policymakers, civil society organisations and other partners who can contribute to translating research into practical solutions.

Assoc. Prof. Angelina Kakooza Mwesigye, Associate Professor and Child Neurologist at Makerere University College of Health Sciences, also emphasised the importance of exposing young people to international research opportunities.

She said the long standing Uganda Europe partnership provides opportunities for the next generation of researchers to learn, build networks and prepare for future research collaborations.

The School of Public Health’s participation highlighted the role of international partnerships in strengthening research capacity, supporting innovation and developing evidence based responses to Uganda’s public health challenges.

Allan Ainematsiko

Bachelors of Journalism and Communication

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