Acute care for the three leading causes of mortality in lower-middle-income countries: A systematic review

Area of Science:

• Global Health
• Critical Care Medicine
• Epidemiology

Background:

• Ischemic heart disease (IHD), stroke, and lower respiratory infections (LRIs) are leading causes of mortality in lower-middle-income countries (LMIC).
• Patients in LMIC often face healthcare barriers, leading to critical disease presentation.
• Published critical care implementations in LMIC lack formal review.

Purpose of the Study:

• To systematically review published literature on acute care interventions for IHD, stroke, and LRIs in LMIC.
• To identify successful diagnostic and treatment measures implemented in LMIC.
• To highlight research gaps, particularly in Central and South America.

Main Methods:

• Systematic literature review of PubMed indexed studies up to October 2017.
• Inclusion criteria: human studies in English, French, or Spanish, conducted in LMIC, with quantitative data on acute care for IHD, stroke, and LRI.
• Initial search yielded 4994 abstracts; 161 manuscripts were selected after screening.

Main Results:

• The review identified 161 relevant manuscripts, predominantly from Asia.
• Successful diagnostic and treatment measures were demonstrated for IHD, stroke, and LRI in LMIC settings.
• Significant lack of original research from Central and South America was noted.

Conclusions:

• Acute care interventions for IHD, stroke, and LRIs have been successfully studied and published in LMIC.
• Specific interventions include monitoring, medications, thrombolytics, percutaneous intervention, coronary artery bypass graft for IHD; therapeutic hypothermia, medications, thrombolytics for stroke; and oxygen saturation measurement, diagnostic ultrasound, oxygen, antibiotics for LRI.
• There is a critical need for more research originating from Central and South America to address these major causes of mortality in LMIC.