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Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Eva Miranda Marwali1,2, Aria Kekalih3, Saptadi Yuliarto4

  • 1Department of Pediatric Cardiac Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia eva.marwali@pjnhk.go.id.

BMJ Paediatrics Open
|January 16, 2023
PubMed

Insights

Children in low-income to middle-income countries (LMICs) faced higher COVID-19 mortality rates compared to high-income countries (HICs). Disparities in treatment access and higher complication rates contributed to this increased risk in LMICs.

Area of Science:

  • Global Health
  • Infectious Diseases
  • Paediatric Medicine

Background:

  • The COVID-19 pandemic disproportionately affected paediatric populations globally.
  • Significant variations in clinical outcomes were observed between high-income countries (HICs) and low-income to middle-income countries (LMICs).

Purpose of the Study:

  • To investigate differences in paediatric clinical outcomes during the COVID-19 pandemic.
  • To identify factors contributing to the disparity in outcomes between HICs and LMICs.

Main Methods:

  • Utilized the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database.
  • Included children under 19 with suspected or confirmed COVID-19 admitted to hospital between January 2020 and April 2021.
  • Performed univariate and multivariable analyses to assess mortality risk factors by country income group.

Main Results:

  • Overall in-hospital mortality was 3.3%, higher in LMICs (4.0%) than HICs (1.7%).
  • LMICs showed higher mortality rates among mechanically ventilated children (43.6% vs 7.2% in HICs).
  • Pre-existing comorbidities (TB, HIV) and complications (ARDS, myocarditis) were more prevalent in LMICs, with LMIC status independently associated with increased mortality risk (aHR 4.73).

Conclusions:

  • Paediatric mortality and morbidity from COVID-19 were significantly higher in LMICs compared to HICs.
  • Disparities are likely due to differences in patient demographics, disease complications, and access to essential medical interventions and treatments.
Abstract

Keywords:
Adolescent HealthCOVID-19Health services researchMortalityNeonatology

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