Prevalence of Endotracheal Intubation in Emergency and Intensive Care Settings in Mahajanga, Madagascar

Objective: To evaluate the prevalence of patients with an indication for endotracheal intubation and the proportion of patients actually intubated in emergency departments in Mahajanga, Madagascar.

Design: Prospective, descriptive study conducted over a 4-month period (April–July 2024).

Setting: Emergency and intensive care units across two university hospitals and one private referral hospital in Mahajanga, Madagascar.

Participants: A total of 111 patients with a formal indication for endotracheal intubation were included. Among them, 27 underwent intubation.

Main outcome measures: Prevalence of indicated endotracheal intubation, rate of performed intubation, clinical characteristics, and factors associated with non-intubation.

Results: The prevalence of patients requiring endotracheal intubation was 24.3%. Most patients presented with severe clinical conditions, including impaired consciousness (52.3% with Glasgow Coma Scale <8) and respiratory distress (58.6%). Neurological conditions were the most frequent indications. Intubation was performed in only 24.3% of indicated cases. The main barriers to intubation included lack of qualified personnel (33.3%), limited experience, and clinical instability. Overall mortality was high (95.2%), particularly among patients not intubated.

Conclusion: There is a substantial gap between the need for and the actual performance of endotracheal intubation in emergency settings in Madagascar. System-level constraints, particularly human resources and training deficits, appear to significantly impact airway management and patient outcomes. Strengthening emergency airway training and improving access to critical care resources may help reduce avoidable mortality.