Evaluation of the Resources and Inequities Among Pediatric Critical Care Facilities in Pakistan

Abstract

OBJECTIVES: To evaluate nationwide pediatric critical care facilities and resources in Pakistan. DESIGN: Cross-sectional observational study. SETTING: Accredited pediatric training facilities in Pakistan. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey was conducted using the Partners in Health 4S (space, staff, stuff, systems) framework, via email or telephone correspondence. We used a scoring system in which each item in our checklist was given a score of 1, if available. Total scores were added up for each component. Additionally, we stratified and analyzed the data between the public and private healthcare sectors. Out of 114 hospitals (accredited for pediatric training), 76 (67%) responded. Fifty-three (70%) of these hospitals had a PICU, with a total of 667 specialized beds and 217 mechanical ventilators. There were 38 (72%) public hospitals and 15 (28%) private hospitals. There were 20 trained intensivists in 16 of 53 PICUs (30%), while 25 of 53 PICUs (47%) had a nurse-patient ratio less than 1:3. Overall, private hospitals were better resourced in many domains of our four Partners in Health framework. The Stuff component scored more than the other three components using analysis of variance testing (p = 0.003). On cluster analysis, private hospitals ranked higher in Space and Stuff, along with the overall scoring. CONCLUSIONS: There is a general lack of resources, seen disproportionately in the public sector. The scarcity of qualified intensivists and nursing staff poses a challenge to Pakistan’s PICU infrastructure.

Publications in pediatric critical care medicine: trends from Pakistan

“…Abbas Q et al reported that of all the PICUs surveyed in the country, only 30% were staffed by paediatricians with training in PCCM. 12 Despite these documented barriers, the specialty has seen significant growth in recent years13m which is reflected by the linear growth of research output from the country noted in the current study. Several reasons come to mind for this increased output.…”

“…16 For every 500,000 Pakistani children age <14, there exists only 1 PICU bed compared to 1 bed/10,000 children in the United States and 1/1000 children in the United Kingdom. 12 This translates to a severe shortage of trained PCCM personnel. Those that exist experience an overwhelming volume of clinical work, especially in public-sector hospitals.…”

“…Abbas Q et al in their survey of paediatric intensive care units (PICUs) across the country, highlighted the issues. 12 Despite the hurdles, a steady output of literature has persisted. 13 The current study was planned to analyse the characteristics of PCCM research published from Pakistan.…”

Novel data visualization and risk analytic algorithm in a low-middle income country

“…While the general nurse-to-patient ratio in Pakistan is 1:50, in ICUs this ratio is 1:1.3-to-1:1.7, well below the expectation in developed countries (ratio 1: 1-to-2). 6 Task sharing and shifting is a concept being used by many healthcare systems and is also promoted by the WHO 7 to help address the shortage of healthcare workers in LMICs. Technology and clinical decision support systems (CDDS) can be used to augment the awareness of an evolving clinical state and timely communication intervention by less skilled healthcare workers in LMICs.…”