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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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The 92nd Guild Ministry of Health Back with the Annual Guild Medical Camp

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Participants visit the STI Screening Tent during the Annual Medical Camp in 2025. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

The 92nd Guild Ministry of Health is set to host the Annual Makerere Guild Medical Camp, a three-day outreach that will bring free and essential medical services to students, staff, and the surrounding community. The camp will run from 17th to 19th September 2026, from 8:00am to 5:00pm each day, at the Freedom Square.

Themed around promoting student wellness for academic excellence, the medical camp is organised under the leadership of Hon. Wamezaya Ebenezer, the Minister of Health in the 92nd Guild Government, in alliance with several partner organisations supporting the university’s health and wellness agenda. The initiative reflects a growing recognition within student leadership circles that academic performance is closely tied to the physical and mental wellbeing of the university community.

Comprehensive Range of Services

The medical camp will offer a wide range of services designed to address both routine and specialised health needs. On the general health side, attendees will have access to general and specialist medical consultations, allowing students, staff, and community members to seek professional advice on a variety of health concerns without the usual costs associated with private or even public healthcare.

A female medical personnel attends to a male client. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
A female medical personnel attends to a male client.

Screening services will also be a central feature of the camp. Organisers have confirmed that sickle cell testing, malaria rapid diagnostic testing, and HIV screening will be available on site, giving participants the opportunity to know their status and receive guidance on appropriate next steps. Eye care services and laboratory diagnostics will round up this category, addressing common but often neglected areas of student health.

Beyond diagnostics and consultations, the camp will provide free essential medicines to those who need them, easing the financial burden that often accompanies treatment even after a diagnosis has been made. Reproductive health counseling will also be offered, giving students a confidential space to discuss matters that are frequently overlooked in general campus health conversations. Mental health counseling completes the list of available services, an inclusion that speaks to the increasing attention being paid to psychological wellbeing within the university community.

A Camp Open to the Wider Community

While the camp is organised by the Guild Ministry of Health and centred on student welfare, its reach extends beyond the student body. Organisers have made it clear that the free medical services will be available to students, staff, and members of the whole Makerere community, positioning the event as a broader public health contribution rather than a strictly internal university affair. This inclusive approach mirrors similar outreach efforts previously undertaken by student leadership and university departments, which have sought to position Makerere University not just as a centre of learning but as an active contributor to community welfare in the areas surrounding its campuses.

A male client gets his BMI checked. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
A male client gets his BMI checked.

Freedom Square, long regarded as the symbolic heart of student activity and expression at Makerere University, was selected as the venue for the three day event. Its central location and historic significance make it an accessible and fitting site for an initiative of this scale, expected to draw considerable numbers of participants over the course of the camp.

Health as a Pillar of Academic Success

The organisers have anchored the medical camp around the message of promoting student wellness for academic excellence, a theme that underscores the connection between health and academic performance. University life often places significant demands on students, both physically and mentally, and untreated health concerns can quietly undermine academic progress long before they become visible crises. By bringing screening, treatment, and counseling services directly to students at no cost, the Guild Ministry of Health is addressing barriers that might otherwise prevent students from seeking care, whether due to cost, distance, or stigma, particularly around mental health and reproductive health matters.

The 91st Guild Minister of Health, Hon. Bbosa Sharif (L) poses by the event banner in the Freedom Square. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
The 91st Guild Minister of Health, Hon. Bbosa Sharif (L) poses by the event banner in the Freedom Square.

The inclusion of mental health counseling alongside more traditional physical health services is particularly notable. It signals an evolving understanding among student leaders that wellness cannot be addressed through physical checkups alone, and that psychological support deserves equal standing within campus health initiatives. Similarly, the presence of reproductive health counseling reflects an effort to normalise conversations that many young people find difficult to initiate on their own.

What to Expect

Over the three days, participants can expect a structured environment at Freedom Square, with separate service points catering to the different categories of care on offer. Medical professionals will be on hand to conduct consultations and screenings, while counselors will provide guidance on reproductive and mental health matters in a setting designed to protect privacy and encourage openness.

Given the scale of services on offer and the open invitation extended to staff and community members in addition to students, organisers anticipate strong turnout throughout the three day period. Those interested in attending are encouraged to plan their visits within the stated hours of 8:00am to 5:00pm to take full advantage of the services available.

H.E. Bbosa Sharif receives female students at the Medical Camp. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
H.E. Bbosa Sharif receives female students at the Medical Camp.

For any inquiries regarding the medical camp, members of the university community and the public have been directed to reach out to Hon. Wamezaya Ebenezer, the Minister of Health, through the contact provided by the Guild Ministry of Health.

Building on a Guild Tradition

The Annual Makerere Guild Medical Camp is not a new concept within student governance at the university. Successive Guild Ministries of Health have used the medical camp as a recurring platform through which they translate campaign promises around student welfare into visible action. Each edition tends to build on the lessons of the one before it, with organisers typically expanding the range of services offered as new partnerships are secured and as feedback from previous camps is incorporated into planning.

Sickle Cell Screening (Left Tent) was one of the services offered. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
Sickle Cell Screening (Left Tent) was one of the services offered.

This year’s edition, organised under the 92nd Guild Ministry of Health, appears to place particular emphasis on breadth of service, combining preventive screening, curative consultation, and psychosocial support within a single three-day window. The decision to bundle sickle cell testing, malaria and HIV screening alongside eye care and laboratory diagnostics suggests an intention to make the camp a one stop point for health assessment, reducing the need for participants to seek out multiple providers across the city for basic checks they might otherwise postpone indefinitely.

Why Timing Matters

The scheduling of the camp in September places it at a point in the academic calendar when many students are settling back into campus life after recess, a period during which health concerns accumulated over the break, whether physical ailments left unattended or emerging mental health pressures tied to academic anxiety, tend to surface. Offering free consultations and counseling at this juncture allow students to address these concerns early, before they compound into more serious complications that could interfere with coursework, examinations, or general campus participation.

A female medical personnel attends to a female client. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
A female medical personnel attends to a female client.

For staff members and residents of the areas surrounding the university, the timing also offers a convenient opportunity to access services that might otherwise require travel to distant health facilities or extended waiting periods within an already strained public health system. In this sense, the camp functions as a modest but meaningful supplement to existing healthcare provision in the vicinity of the university.

As the 17th of September approaches, the Annual Makerere Guild Medical Camp stands as another example of the Guild Ministry of Health stepping beyond the boundaries of policy and advocacy into direct, hands-on service delivery, a model that continues to shape the character of guild ministries at Makerere University. Students, staff, and members of the surrounding community are encouraged to take advantage of the free services on offer and to look out for further communication from the Guild Ministry of Health as the event draws closer.

For more info, reach Hon. Wamezaya on +256784541248

Philemon Akoragye.
Philemon Akoragye

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Call for Applications: Short-term Positions under the STOP-AMDR Project

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The Makerere University School of Public Health (MakSPH) Building, Mulago Hospital Complex. Kampala Uganda, East Africa.

Makerere University School of Public Health, in collaboration with Jhpiego, invites applications for 49 short-term positions under the Scaling the Optimal Use of Multiple ACTs to Prevent Antimalarial Drug Resistance (STOP-AMDR) Project.

The available positions are:

Qualitative Research Assistants (8): https://sph.mak.ac.ug/careers/?view_job=20784

Enumerators (35): https://sph.mak.ac.ug/careers/?view_job=20783

Field Supervisors (4): https://sph.mak.ac.ug/careers/?view_job=20780

Costing Research Assistants (2): https://sph.mak.ac.ug/careers/?view_job=20786

The short-term assignments will support data collection in Buikwe and Busia districts, with some national-level activities. Applicants are encouraged to review the requirements for their preferred position before applying.

Application link: https://shorturl.at/IYFv1

Application deadline: Wednesday, 2 September 2026 at 4:00 PM EAT.

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MakSPH Takes Mpox Response Lessons to Districts for Stronger Outbreak Preparedness

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Participants at the Mpox response study dissemination meeting in Amuru District on 10 August 2026. Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, research dissemination of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge Districts Uganda, East Africa, 10th-14th August 2026.

By Muhammad Jjumba

Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, has shared findings from its study of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge districts to strengthen district preparedness for future outbreaks.

The Africa-Europe CoRE is a partnership co-led by MakSPH and the Centre for Research on the Epidemiology of Disasters at UCLouvain, Belgium. It brings together universities in Africa and Europe to strengthen research, training and preparedness for pandemics and other public health shocks.

The district-level dissemination meetings, held from 10 to 14 August 2026, brought together more than 100 local government, health and security officials, Village Health Teams, implementing partners and community representatives. The meetings enabled stakeholders to validate the district-level findings, identify practical actions and provide feedback for the study’s final analysis and national dissemination.

Mr. Philliam Jabim shares the Mpox response study findings with participants during the dissemination meeting in Nakasongola District on 12 August 2026. Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, research dissemination of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge Districts Uganda, East Africa, 10th-14th August 2026.
Mr. Philliam Jabim shares the Mpox response study findings with participants during the dissemination meeting in Nakasongola District on 12 August 2026.

Uganda confirmed its first two Mpox cases on 24 July 2024 at Bwera Hospital in Kasese District. The Ministry of Health declared an outbreak on 2 August 2024. As documented in the study, the response involved health workers, communities, local governments, security agencies, political leaders, and implementing partners.

In response to the outbreak, a MakSPH research team led by Prof. Rhoda Wanyenze, Dr. Rawlance Ndejjo, Dr. Steven Kabwama and Mr. Douglas Bulafu conducted a study in May 2025 to assess Uganda’s Mpox response, including its policies, interventions, strategies and challenges, and generate lessons to inform recovery and strengthen preparedness for future public health emergencies.

Using purposive sampling, the research team conducted 20 key informant interviews and five focus group discussions in each of the four districts, drawing perspectives from western Uganda in Kasese, northern Uganda in Amuru, central Uganda in Nakasongola and eastern Uganda in Mayuge.

Participants and the MakSPH research team at the Mpox response study dissemination meeting in Nakasongola District on 12 August 2026. Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, research dissemination of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge Districts Uganda, East Africa, 10th-14th August 2026.
Participants and the MakSPH research team at the Mpox response study dissemination meeting in Nakasongola District on 12 August 2026.

The study, titled Assessment of the Mpox Response in Uganda: Documenting Challenges, Lessons and Innovations to Strengthen Emergency Preparedness and Response Capacities, was funded by the Government of Uganda through the Makerere University Research and Innovation Fund (Mak-RIF).

“This study is helping us move beyond recounting the Mpox response to identifying the actions that districts and national partners can take before the next outbreak. By validating the findings with stakeholders who led and experienced the response, we are ensuring that the evidence reflects local realities and can inform stronger surveillance, risk communication, coordination and community engagement,” said Mr. Bulafu, who led the MakSPH team during the dissemination meeting in Amuru.

Mr. Douglas Bulafu engages participants during the Mpox response study dissemination meeting in Amuru District on 10 August 2026. Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, research dissemination of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge Districts Uganda, East Africa, 10th-14th August 2026.
Mr. Douglas Bulafu engages participants during the Mpox response study dissemination meeting in Amuru District on 10 August 2026.

In Amuru, the 10 August meeting brought together over 25 stakeholders from the district health team, political leadership, security agencies, Village Health Teams, implementing partners and the community. On the same day, a second MakSPH team, led by Mr. Keneth Sebukeera and Mr. Filimin Niyongabo, convened stakeholders in Kasese for a parallel validation meeting. The consultations then continued in Nakasongola on 12 August and concluded in Mayuge on 14 August, extending the study’s engagement across all four districts.

Across the districts, stakeholders said the results reflected their experience during the outbreak. They pointed to strengths in leadership, coordination, community engagement and partner support, while also describing gaps in documentation, logistics, diagnostic access, staffing, risk communication, public trust and continuity of essential health services.

They also noted inconsistent implementation of the World Health Organization (WHO) 7-1-7 target, which calls for detecting a suspected outbreak within seven days, notifying public health authorities within one day and completing early response actions within seven days.

The MakSPH research team, led by Mr. Keneth Sebukeera and Mr. Filimin Niyongabo, with participants during the Mpox response study dissemination meeting in Kasese District on 10 August 2026. Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, research dissemination of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge Districts Uganda, East Africa, 10th-14th August 2026.
The MakSPH research team, led by Mr. Keneth Sebukeera and Mr. Filimin Niyongabo, with participants during the Mpox response study dissemination meeting in Kasese District on 10 August 2026.

In Kasese, stakeholders highlighted gaps in documentation, financial and logistical resources, and human resources. They identified Village Health Teams and grassroots, religious and cultural leaders as important resources for community surveillance and risk communication. They called for stronger collaboration between technical and non-technical leaders, engagement with traditional healers, greater use of local radio for public sensitisation, and better facilitation of district epidemic response teams to reach distant communities.

Amuru participants called for proactive preparedness in the border district, citing misinformation and rumours as barriers to risk communication. They urged timely, accurate information from health workers and other authorities; training in disease surveillance and grant writing to strengthen capacity and resource mobilisation; and compassionate care, psychosocial support and community awareness to reduce stigma and support survivor reintegration.

During the meeting in Nakasongola, stakeholders identified Community Health Workers and Community Health Extension Workers as potential resources for strengthening community surveillance and addressing workforce shortages. Given the district’s position around Lake Kyoga and along the Kampala-South Sudan transit corridor, they also called for stronger documentation, note-taking and reporting, accurate real-time information, closer communication with the Ministry of Health, and collaboration among technical, political, religious and community leaders.

Ms. Eunice Vivian Asingo, Senior Nursing Officer at Nakasongola Health Centre IV, contributes to the discussion during the Mpox response study dissemination meeting in Nakasongola District on 12 August 2026. Makerere University School of Public Health (MakSPH), through the Africa-Europe Cluster of Research Excellence (CoRE) for Preparedness and Response to Pandemics and Shocks, research dissemination of Uganda’s Mpox response with stakeholders in Kasese, Amuru, Nakasongola and Mayuge Districts Uganda, East Africa, 10th-14th August 2026.
Ms. Eunice Vivian Asingo, Senior Nursing Officer at Nakasongola Health Centre IV, contributes to the discussion during the Mpox response study dissemination meeting in Nakasongola District on 12 August 2026.

Ms. Eunice Vivian Asingo, Senior Nursing Officer at Nakasongola Health Centre IV, called for a permanent, adequately resourced outbreak-management centre to help protect routine services during future epidemics. “We appeal for better facilities to manage epidemics and outbreaks. At Nakasongola Health Centre IV, spaces previously used for outbreak management have been repurposed for other services, and we have limited staff. During the Mpox response, colleagues assigned to manage patients later returned to the general team, creating fear among staff already under pressure,” she said.

In Mayuge, Dr. Basembeza highlighted leadership, coordination and surveillance structures operating from district to community level as important factors in the response. He said the structures enabled the district to receive and respond quickly to community alerts. “Whenever there is a rumour or an alert, we are able to respond. Within 20 minutes, we had a response because of the structure we have,” Dr. Basembeza said.

Based on the findings, the research team recommends increased preparedness financing, stronger community engagement, decentralised diagnostic services through stronger district laboratory capacity, and improved health information and research systems.

Across the four districts, stakeholders reaffirmed that trusted community structures and coordinated action across sectors are essential to strengthening outbreak preparedness.

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