A hospital stay is meant to bring relief, but for thousands of patients across Africa, it can also mean enduring severe pain. According to a study led by researchers at the University of Cape Town (UCT), 14.4% of hospital patients experienced severe pain, defined as a score of seven or more out of 10. The study, which involved 19,438 patients in 180 hospitals across 22 African countries, provides the first large-scale evidence of the burden of acute pain among hospitalized patients across Africa.
The study found that 67.9% of adults admitted to hospitals across Africa experienced some level of pain, while 28% reported mild pain, 25.4% moderate pain, and 14.4% severe pain. About one-third of patients reported no pain. Pain was particularly common among patients who had been admitted after trauma, with 84.1% experiencing pain and 20.3% reporting severe pain. This was higher than among patients admitted with non-communicable diseases.
The researchers found that patients in surgical wards reported more pain than those in medical wards, with 16.2% reporting severe pain compared with 11.1% in medical wards. High-care units recorded one of the highest levels of severe pain, at 19.3%, compared with 14% in general wards. The median pain score among all patients was three out of 10. The researchers also found no evidence that pain severity was associated with whether a patient was classified as critically ill.
The study found no meaningful overall difference in pain severity between men and women. However, a different pattern emerged when researchers looked at deaths. After taking other factors into account, increasing pain severity was associated with increased odds of dying in hospital within seven days. Patients with severe pain were more likely to die within seven days than those without severe pain.
The researchers stressed that the finding should not be interpreted to mean severe pain causes death, as the study was observational and cannot establish cause and effect. Severe pain could instead be a sign of an underlying illness or injury that makes a patient more vulnerable to poor outcomes. The study did not record which pain medicines or other treatments patients received.
Dr. Gillian Bedwell, a postdoctoral fellow in UCT's African Pain Research Initiative who led the study, said further research was needed to understand the relationship between pain and poor outcomes. The findings also highlight how little is known about pain among hospital patients in Africa, with previous international estimates largely coming from high-income countries.
The researchers said the next step is to establish how pain is assessed and managed in African hospitals and to understand what prevents patients from receiving effective pain relief. They also want to identify strategies that could improve pain management in Africa's hospitals. The study involved patients from 22 countries and territories, including South Africa, Botswana, Lesotho, Namibia, Nigeria, Ghana, Kenya, Tanzania, Uganda, Zimbabwe, Mozambique, and Morocco.
Key points
- 14.4% of hospital patients across Africa experience severe pain.
- 67.9% of adults admitted to hospitals across Africa experience some level of pain.
- Increasing pain severity is associated with increased odds of dying in hospital within seven days.
