TY - JOUR
T1 - Etiology of hospital mortality in children living in low- and middle-income countries
T2 - a systematic review and meta-analysis
AU - Kortz, Teresa B.
AU - Mediratta, Rishi P.
AU - Smith, Audrey M.
AU - Nielsen, Katie R.
AU - Agulnik, Asya
AU - Gordon Rivera, Stephanie
AU - Reeves, Hailey
AU - O’Brien, Nicole F.
AU - Lee, Jan Hau
AU - Abbas, Qalab
AU - Attebery, Jonah E.
AU - Bacha, Tigist
AU - Bhutta, Emaan G.
AU - Biewen, Carter J.
AU - Camacho-Cruz, Jhon
AU - Coronado Muñoz, Alvaro
AU - deAlmeida, Mary L.
AU - Domeryo Owusu, Larko
AU - Fonseca, Yudy
AU - Hooli, Shubhada
AU - Wynkoop, Hunter
AU - Leimanis-Laurens, Mara
AU - Nicholaus Mally, Deogratius
AU - McCarthy, Amanda M.
AU - Mutekanga, Andrew
AU - Pineda, Carol
AU - Remy, Kenneth E.
AU - Sanders, Sara C.
AU - Tabor, Erica
AU - Teixeira Rodrigues, Adriana
AU - Yuee Wang, Justin Qi
AU - Kissoon, Niranjan
AU - Takwoingi, Yemisi
AU - Wiens, Matthew O.
AU - Bhutta, Adnan
AU - Global Health Subgroup of the Pediatric Acute Lung Injury Sepsis Investigators (PALISI) Network
PY - 2024/6/7
Y1 - 2024/6/7
N2 - In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%–4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9–14)]; respiratory [9 (95% CI 5–13)]; and gastrointestinal [9 (95% CI 6–11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231–280)]; infectious [214 (95% CI 193–234)]; and gastrointestinal [166 (95% CI 143–190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.
AB - In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%–4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9–14)]; respiratory [9 (95% CI 5–13)]; and gastrointestinal [9 (95% CI 6–11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231–280)]; infectious [214 (95% CI 193–234)]; and gastrointestinal [166 (95% CI 143–190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.
KW - hospital death
KW - resource-limited settings
KW - low- and middle-income countries
KW - critical illness
KW - acute illness
KW - hospital admission
KW - global health
U2 - 10.3389/fped.2024.1397232
DO - 10.3389/fped.2024.1397232
M3 - Review article
SN - 2296-2360
VL - 12
JO - Frontiers in pediatrics
JF - Frontiers in pediatrics
M1 - 1397232
ER -