Good-quality research: a vital step in improving outcomes in paediatric intensive care units in low- and middle-income countries

Abstract

Child mortality in Africa is high and there are an estimated 3.5 million deaths annually in under-5s [1]. A proportion of these deaths will have occurred in hospital where inpatient mortality rates are relatively high (15-30%) [2][3][4], but the overall number of paediatric admissions either of those who survived or died has not been estimated as data have not been consistently collected by health services across countries. Many children presenting to hospital in sub-Saharan Africa arrive with severe forms of common childhood illnesses (especially malaria, diarrhoea, pneumonia, sepsis and meningitis) [2]. Over half the deaths in these children occur within the first 24 hours of admission, which illustrates how crucial it is to commence appropriate treatment quickly. Although this high immediate mortality may be partly because of delays in reaching hospital or failure to implement triage and early treatment [5], it is also because few children will ever be managed in an intensive care unit since these are lacking in most hospitals across Africa. Management of the sick child is an important goal in reducing child mortality in low-and middle-income countries (LMIC) [6], and developing more effective emergency and intensive care services for children has been identified as crucial to making reductions [7]. Improving these emergency care services need not involve complex and expensive interventions: integration with other hospital services, prioritising the critically ill and introducing simple emergency treatments would be effective [8]. In addition, a vital step in achieving these objectives is good-quality research, including clinical trials of interventions in the emergency room. Many recommendations lack an adequate evidence base since the relevant research in LMIC settings is limited [9].

A Prognostic Model for Critically Ill Children in Locations With Emerging Critical Care Capacity*

“…Furthermore, prognosis is influenced by the level of care available and underlying host susceptibility states, and hence adapted tools are required to support context-specific clinical decision-making (5,7,8). There have been calls to validate existing severity scores and develop new risk stratification tools for resourceconstrained PICUs (5,9). Unfortunately, most studies from LMIC PICUs are limited to urban centers, hampered by small sample sizes, and use methods incompatible with development of robust clinical severity scores or prediction models (10)(11)(12)(13)(14).…”