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Evaluation of the implementation of the Critical Care Asia and Africa Intensive Care Unit registry in Ethiopia
Adam D Laytin, Ayalew Zewdie, Menbeu Sultan, Amelia J Brandt, Ararso B Olani, Geremew Werkeshe, Sean M Berenholtz, William Checkley, Bhakti Hansoti
Adam D Laytin, Sean M Berenholtz, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Ayalew Zewdie, Menbeu Sultan, Ararso B Olani, Geremew Werkeshe, Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa 1271, Ethiopia
Amelia J Brandt, Department of Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Balitmore, MD 21287, United States
William Checkley, Department of Medicine, Division of Pulmonology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Bhakti Hansoti, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Author contributions: Laytin AD, Zewdie A, Sultan M, Berenholtz SM, Checkley W, and Hansoti B conceptualized the study; Laytin AD curated the data; Laytin AD, Brandt AJ, Olani AB, and Werkeshe G participated in coding and formal analysis; Laytin AD and Berenholtz SM acquired funding; Laytin AD, Olani AB, and Werkeshe G participated in investigation; Laytin AD, Zewdie A, Sultan M, Brandt AJ, Berenholtz SM, Checkley W, and Hansoti B developed the methodology; Zewdie A and Sultan M supervised the data collection; Laytin AD, Brandt AJ, and Hansoti B wrote the original draft of the article; Zewdie A, Sultan M, Olani AB, Werkeshe G, Checkley W, and Berenholtz SM reviewed and edited the submitted version of the article; Berenholtz SM passed away prior to finalization of the article; and all other authors have read and approved the final manuscript.
Supported by Society for Academic Emergency Medicine Foundation, No. AG2020-0000000136; and a StAAR Mentored Training Award from the JHU SOM Department of Anesthesiology and Critical Care Medicine.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Johns Hopkins School of Medicine, approval No. IRB00296477; and St. Paul Hospital Millennium Medical College, approval No. PM 23-1310.
Informed consent statement: All respondents provided verbal informed consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Not applicable.
Corresponding author: Adam D Laytin, MD, Assistant Professor, Department of Anesthe
siology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St Bloomberg 6320, Baltimore, MD 21287, United States.
alaytin1@jhmi.edu
Received: October 29, 2025
Revised: December 17, 2025
Accepted: January 21, 2026
Published online: March 9, 2026
Processing time: 122 Days and 16.1 Hours
BACKGROUND
Intensive care unit (ICU) capacity is underdeveloped in sub-Saharan Africa, and outcomes for critical care lag behind higher resource settings. It is essential to understand local case-mix, processes of care and clinical outcomes in African ICUs to close these gaps. To this end, ICU registries are valuable tools for clinical research, quality improvement and capacity building. The Critical Care in Asia and Africa (CCAA) Network has specially developed a novel ICU registry for resource-limited settings.
AIM
To evaluate the feasibility, acceptability, and perceived sustainability of the CCAA ICU registry in the Ethiopian clinical context.
METHODS
Eight months following the pilot implementation of the CCAA ICU registry at two academic medical centers in Addis Ababa, Ethiopia, we conducted a qualitative evaluation. We conducted key informant interviews and focus group discussions with members of the ICU registry team, medical and nursing staff, and leadership team. We coded and analyzed transcripts deductively using a thematic content approach.
RESULTS
Emergent themes related to feasibility included data collection, data quality and factors necessary for success. Those related to acceptability included utility, accessibility and comparison to other methods. Those related to perceived sustainability included institutional future, ownership and expansion. Overall, respondents felt that the CCAA ICU registry was feasible and acceptable in their ICUs. They identified important threats to perceived sustainability including multiple channels of communication and infrastructure and human resource limitations, and proposed adaptations to address these threats.
CONCLUSION
The CCAA ICU registry is a promising tool for research and quality improvement in ICUs in sub-Saharan Africa, but successful implementation requires a clear understanding of regional and institutional influencing factors.
Core Tip: In this study, implementation of the Critical Care Asia and Africa Intensive Care Unit registry was evaluated at two hospitals in Addis Ababa, Ethiopia. The implementation was considered an overall success by respondents, who commented positively on the registry’s feasibility and acceptability. This study identified key barriers and facilitators to implementation and threats to sustainability, including essential resources, communication, training, supervision and leadership. These findings can inform adaptations to the registry to optimize implementation and scale-up in the sub-Saharan Africa context.
