DOI: 10.12688/wellcomeopenres.24940.1 ISSN: 2398-502X

Implementation of a National Intensive Care Registry in Uganda (ICRU): Strengthening Critical Care through Data-Driven Approaches in a Low-Income Country

Connie Baluka, Adam Hewitt-Smith, Alice Nuwagira, Martha Alupo, Patience Atumanya, Nodreen Ayupo, Abi Beane, Fred Bulamba, Arjen Dondorp, Rashan Haniffa, Andrew Kamau, Denis Kakaire, Grace Kekirunga, Joshua Muhanguzi, Betty Khainza, Herbert Kiwalya, Joseph Kiwanuka, Chamira Kodippily, Christine Mugala, Arthur Mwanje, Jane Nakibuuka, Charles Ssendikadiwa, Carol Nakyanzi, Sylvia Nawakonyi, Dominic Ogwal, Kenneth Tomanya, Joshua Orikiza, Luigi Pisani, Charles Olaro, Arthur Kwizera, Cornelius Sendagire
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Background National ICU registries are increasingly being implemented in low- and middle-income countries (LMICs) to support resource mapping, patient care evaluation, and data-driven quality improvement. The Intensive Care Registry of Uganda (ICRU) was launched in 2020 to strengthen critical care services through standardized data collection, benchmarking, and research facilitation. This article describes the implementation of ICRU, its contributions to critical care in Uganda, and lessons learned during operationalization. Methods ICRU was established as a cloud-based registry using standardized nomenclature (SNOMED-CT) to ensure interoperability. Participating ICUs employed dedicated data collectors supported by centralized training, IT assistance, and quality assurance mechanisms. Data were collected across admission, daily care, and discharge domains. Challenges, including staffing constraints, ethical approvals, and internet limitations, were addressed through targeted mitigation strategies. Results Between 2020 and 2024, ICRU expanded from 5 to 11 ICUs, capturing nearly 3,800 consecutive admissions and achieving >95% completeness across 33 core variables. The registry enabled real-time tracking of ICU occupancy and critical resource utilization, supported benchmarking with risk-adjusted outcome measures (including e-TROPIcs), and embedded context-appropriate quality indicators. Registry data have informed national quality improvement initiatives, site-level process monitoring, and have supported observational and interventional studies such as MOTIVATE-ICU and ARISE-Africa. Conclusion ICRU demonstrates the feasibility of implementing a national ICU registry in a low-resource setting. By enabling benchmarking, quality improvement, and research, it provides a scalable model for LMICs seeking to strengthen critical care through data-driven approaches. Future priorities include nationwide expansion, integration with the national Health Management Information System (HMIS), and participation in multinational benchmarking and adaptive trials.

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