Fiona Muttalib1, Sebastián González-Dambrauskas, Jan Hau Lee, Mardi Steere, Asya Agulnik, Srinivas Murthy, Neill K J Adhikari. 1. Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada. Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay. Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay. Children's Intensive Care, KK Women's and Children's Hospital, Singapore. Department of Pediatrics, Duke-NUS Medical School, Singapore. Pediatric Acute and Critical Care Medicine Asian Network. Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya. Pediatric Emergency and Critical Care Africa. Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia. Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN. Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada. Sunnybrook Research Institute, Toronto, ON, Canada. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
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.
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 illchildren in resource-limited settings. Minimum standards for essential pediatric emergency and critical care in resource-limited settings are needed.
Authors: Nicholas A Ettinger; Nathan Serazin; Richard Nguyen; Jennifer Werdenberg; Minke Huibers; Susan Torrey Journal: BMC Pediatr Date: 2021-11-27 Impact factor: 2.125
Authors: Ashley Bjorklund; Tina Slusher; Louise Tina Day; Mariya Mukhtar Yola; Clark Sleeth; Andrew Kiragu; Arianna Shirk; Kristina Krohn; Robert Opoka Journal: Front Pediatr Date: 2022-01-31 Impact factor: 3.418
Authors: Qalab Abbas; Adrian Holloway; Paula Caporal; Eliana López-Barón; Asya Agulnik; Kenneth E Remy; John A Appiah; Jonah Attebery; Ericka L Fink; Jan Hau Lee; Shubhada Hooli; Niranjan Kissoon; Erika Miller; Srinivas Murthy; Fiona Muttalib; Katie Nielsen; Maria Puerto-Torres; Karla Rodrigues; Firas Sakaan; Adriana Teixeira Rodrigues; Erica A Tabor; Amelie von Saint Andre-von Arnim; Matthew O Wiens; William Blackwelder; David He; Teresa B Kortz; Adnan T Bhutta Journal: Front Pediatr Date: 2022-01-28 Impact factor: 3.418
Authors: Asya Agulnik; Gia Ferrara; Maria Puerto-Torres; Srinithya R Gillipelli; Paul Elish; Hilmarie Muniz-Talavera; Alejandra Gonzalez-Ruiz; Miriam Armenta; Camila Barra; Rosdali Diaz; Cinthia Hernandez; Susana Juárez Tobias; Jose de Jesus Loeza; Alejandra Mendez; Erika Montalvo; Eulalia Penafiel; Estuardo Pineda; Dylan E Graetz Journal: JAMA Netw Open Date: 2022-03-01
Authors: Kelly C Jordan; Jane L Di Gennaro; Amélie von Saint André-von Arnim; Barclay T Stewart Journal: Front Pediatr Date: 2022-07-19 Impact factor: 3.569