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Pediatric Emergency and Critical Care Resources and Infrastructure in Resource-Limited Settings: A Multicountry
Fiona Muttalib1, Sebastián González-Dambrauskas2,3, Jan Hau Lee1,2,3,4,5,6,7,8,9,10,11,12,13,14
1Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
Insights
Essential resources for pediatric critical care are scarce in low-income countries, highlighting a global disparity. This study surveyed healthcare providers to identify critical resource gaps in pediatric emergency and critical care delivery worldwide.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care Medicine
- Global Health
Background:
- Resource-limited settings face significant challenges in delivering pediatric emergency and critical care.
- Existing data on the availability of essential resources for critically ill children in these areas are limited.
Purpose of the Study:
- To describe the current infrastructure and resource availability for pediatric emergency and critical care in resource-limited settings globally.
- To identify disparities in resource allocation based on country income levels.
Main Methods:
- A cross-sectional electronic survey was distributed internationally in November 2019.
- Survey items were developed through literature review and piloting.
- Responses were collected from healthcare providers in resource-limited settings worldwide.
Main Results:
- 328 responses were received from 60 countries, with a predominance from Latin America and Sub-Saharan Africa.
- Significant differences in resource availability were found between country income groups (p < 0.05).
- Lower-income countries reported limited availability of advanced ventilatory support, monitoring, renal replacement therapy, advanced imaging, and essential medications.
Conclusions:
- Contemporary data reveal substantial disparities in essential and advanced resources for critically ill children in resource-limited settings.
- There is a critical need to establish minimum standards for pediatric emergency and critical care in these regions.
Objectives:
To describe the infrastructure and resources for pediatric emergency and critical care delivery in resource-limited settings worldwide.
Design:
Cross-sectional survey with survey items developed through literature review and revised following piloting.
Setting:
The electronic survey was disseminated internationally in November 2019 via e-mail directories of pediatric intensive care societies and networks and using social media.
Patients:
Healthcare providers who self-identified as working in resource-limited settings.
Interventions:
None.
Measurements And Main Results:
Results were summarized using descriptive statistics and resource availability was compared across World Bank country income groups. We received 328 responses (238 hospitals, 60 countries), predominantly in Latin America and Sub-Saharan Africa (n = 161, 67.4%). Hospitals were in low-income (28, 11.7%), middle-income (166, 69.5%), and high-income (44, 18.4%) countries. Across 174 PICU and adult ICU admitting children, there were statistically significant differences in the proportion of hospitals reporting consistent resource availability ("often" or "always") between country income groups (p < 0·05). Resources with limited availability in lower income countries included advanced ventilatory support, invasive and noninvasive monitoring, central venous access, renal replacement therapy, advanced imaging, microbiology, biochemistry, blood products, antibiotics, parenteral nutrition, and analgesic/sedative drugs. Seventy-seven ICUs (52.7%) were staffed 24/7 by a pediatric intensivist or anesthetist. The nurse-to-patient ratio was less than 1:2 in 71 ICUs (49.7%).
Conclusions:
Contemporary data demonstrate significant disparity in the availability of essential and advanced human and material resources for the care of critically ill children in resource-limited settings. Minimum standards for essential pediatric emergency and critical care in resource-limited settings are needed.
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