UCSF

Children in resource-limited settings (RLS) bear a disproportionate burden of mortality; in 2019, 80% of global child deaths were in RLS. Most acute, life-threatening pediatric illnesses can be managed with basic critical care. However, it is unclear how best to deploy existing resources and select interventions for implementation in the absence of data on pediatric acute critical illness (P-ACI) and associated hospital mortality in RLS. This work aimed to estimate the proportion of children with P-ACI and to determine the common causes of pediatric hospital mortality in RLS hospitals. We performed a systematic review and meta-analysis of observational studies from low- and middle-income countries (RLS proxy) to estimate pediatric cause-specific mortality using random-effects models and analyzed differences by region. We also conducted a point prevalence study of acutely ill or injured children seeking care at RLS hospitals and measured the proportion of children with P-ACI. We summarized site- and population-level data by sociodemographic index (SDI) and P-ACI status and tested for an association between SDI and P-ACI with logistic regression modelling. The proportion of P-ACI was 6-29% and hospital mortality was 0-6%, depending on SDI and region, with the highest estimates from the lowest SDI category. P-ACI and mortality were most frequently associated with infectious diseases. A coordinated global effort is needed to increase high-quality critical care services in RLS hospitals to prevent hospital mortality and care for children with life-threatening conditions.