One in seven has severe pain: a point-prevalence study of hospitalised patients across Africa
Abstract
ABSTRACT: Acute pain in hospitalised patients is common, yet African data are scarce. We conducted a prospective point-prevalence study of hospitalised adult patients across Africa to determine acute pain prevalence and severity and investigate associations of pain with critical illness and 7-day mortality. On a single day, investigators assessed patients' worst pain in the preceding 24 hours using a 0 to 10 visual-numerical scale and recorded vital signs. Critical illness was defined as ≥1 vital sign out of range, in line with an international consensus definition. In-hospital mortality was assessed at day 7. Data are presented as median [interquartile range], n (%), and odds ratios with 95% confidence intervals. Between September and December 2023, 19,438 patients from 180 hospitals in 22 African nations were included (age 40 [29; 59] years; 10,874 [56%] female). Pain prevalence [95% CI] was 67.9% [67.9-68.5], with 2795 (14.4%) patients reporting severe pain (≥7/10). Pain was more common among patients admitted for emergency or trauma care and in surgical and high-care wards. Pain severity did not differ meaningfully between sexes. There was no evidence of an association between pain severity and critical illness; however, increasing pain severity was associated with a higher likelihood of 7-day mortality. These findings are comparable to data from high-income countries despite substantial differences in healthcare resources, suggesting that acute pain remains a persistent and underaddressed problem globally. This study provides the first large-scale evidence of acute pain burden in African hospitals and lays a foundation for future research aimed at comprehensively characterising in-hospital pain.
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Authors: Gillian J. Bedwell, Romy Parker, Victoria J. Madden, Juan Scribante, Muhammed Elhadi, Adesoji Ademuyiwa, Babatunde Osinaike, Christian Owoo, Daniel Sottie, Karima Khalid, Adam Hewitt‐Smith, Arthur Kwizera, Fitsum Kifle, Degisew Dersso Mengistu, Yared Boru Firissa, Tirunesh Busha Gemechu, Gaudencia Dausab, Unotjari Kauta, Kaveto Sikuvi, Nahla Kechiche, Kélan Bertille Ki, Martin Mukenga, Dolly M. Munlemvo, Mustapha Bittaye, Abubacarr Jagne, Mohamed Omar, Hassan Ali Daoud, Mohamed Faisal, Mahmoud Elfiky, Mpho Seleke, Tarig Fadalla, Alshaima Koko, Alemayehu Ginbo Bedada, Gilles Niengo Outsouta, Marie Elombila, Ahmed Rhassane El Adib, Meryem Essafti, Dino Lopes de Almeida, Atílio Morais, Pisirai Ndarukwa, Newten Handireketi, Fred Bulamba, Busisiwe Mrara, Hyla‐Louise Kluyts, Marian Kinnes, Abdullahi Said Hashi, Abigail Kusi Amponsah, Aderonke O. Akinpelu, Andrew Amata, Aunel Mallier Peter, Elizabeth Nwasor, Jeremie Kalambay, Hellen N Kariuki, Nana Fening, Nomaqhawe Moyo, P. Mukuna, S Chetty, Sudha Bechan, Tania Pretorius, Bamidele Victor Owoyele, Luyanduthando Mqadi, Hanel Duvenage, Gwendoline Arendse, Luke Hannan, Landon Myer, Carl Otto Schell, Tim Baker, Rupert M. Pearse, Bruce Biccard
Institutions: Karolinska Institutet, London School of Hygiene & Tropical Medicine, University of Oxford, University of the Witwatersrand, Cairo University, Debre Berhan University, Government of Ethiopia, University of Ibadan, University of Cape Town, Groote Schuur Hospital, Uppsala University, Kinshasa General Hospital, University of Kinshasa, University of Surrey, University of Ilorin, Recep Tayyip Erdoğan University, Kwame Nkrumah University of Science and Technology, Cadi Ayyad University, Amoud University, Makerere University, Queen Mary University of London, William Harvey Research Institute, University of Somalia, University of KwaZulu-Natal, Stellenbosch University, University of Monastir, University of Khartoum, Université Joseph Ki-Zerbo, Western Cape Department of Health, Korle Bu Teaching Hospital, Muhimbili University of Health and Allied Sciences, University of Lagos, University of Tripoli, University College Hospital, Ibadan, University of Zambia, University of Zimbabwe, University of Namibia, Bindura University of Science Education, Lagos University Teaching Hospital, National Ribat University, Sefako Makgatho Health Sciences University, Eduardo Mondlane University, Tikur Anbessa Hospital, University of Hargeisa, Nelson Mandela Academic Hospital, University of Nairobi, Marien Ngouabi University, Centre Hospitalier et Universitaire de Brazzaville, South African Tuberculosis Vaccine Initiative, Busitema University, All Africa Leprosy Tuberculosis and Rehabilitation Training Centre, Ministry of Health and Social Services, University of the Gambia, Somaliland University of Technology, Ministry of Health, University of Botswana, Université Mohammed VI des Sciences et de la Santé, Maputo Central Hospital, Ministry of Health and Child Welfare, Ahmadu Bello University Teaching Hospital, Region Sörmland, Center for Clinical Research Dalarna