One in seven has severe pain: A point-prevalence study of hospitalised people across Africa

Acute pain in hospitalised patients is common and is associated with adverse outcomes, yet African data are scarce. We conducted an international prospective point-prevalence study of adult inpatients across Africa to determine pain prevalence and severity, and explored associations with critical illness and survival status. On a single day, investigators assessed patients worst pain in the preceding 24 hours using a 0-10 visual-numerical scale and recorded vital signs. Critical illness was defined as [≥]1 vital sign out of range, according to predefined definitions. Survival was assessed at day 7. Data are presented as median [IQR], n (%), and odds ratios with 95% confidence intervals. Between September and December 2023, 19438 patients from 180 hospitals in 22 African nations were included (age 40 [29; 59] years; 56% female). 67.9% of patients reported pain, with 2795 patients reporting severe pain (pain of [≥]7/10). Pain severity did not differ significantly by sex overall, but females [≤]40 years old, with hypertension or cancer, admitted for trauma or infection, or in surgical wards had higher mean pain ranks than males. Severe pain odds decreased by 11% per standard deviation increase in age. Patients with severe pain had greater odds of critical illness and death within seven days. These findings provide the first large-scale evidence of acute pain burden in African hospitals. Pain is highly prevalent, with one in seven patients reporting severe pain. Future research of effective and feasible strategies to manage acute pain and reduce pain-related adverse clinical outcomes is needed in Africa.