Frontiers in Pediatrics (Jun 2024)
Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis
- Teresa B. Kortz,
- Teresa B. Kortz,
- Rishi P. Mediratta,
- Audrey M. Smith,
- Katie R. Nielsen,
- Asya Agulnik,
- Stephanie Gordon Rivera,
- Hailey Reeves,
- Nicole F. O’Brien,
- Jan Hau Lee,
- Jan Hau Lee,
- Qalab Abbas,
- Jonah E. Attebery,
- Jonah E. Attebery,
- Tigist Bacha,
- Emaan G. Bhutta,
- Carter J. Biewen,
- Jhon Camacho-Cruz,
- Alvaro Coronado Muñoz,
- Mary L. deAlmeida,
- Larko Domeryo Owusu,
- Yudy Fonseca,
- Shubhada Hooli,
- Hunter Wynkoop,
- Mara Leimanis-Laurens,
- Deogratius Nicholaus Mally,
- Amanda M. McCarthy,
- Andrew Mutekanga,
- Carol Pineda,
- Kenneth E. Remy,
- Sara C. Sanders,
- Erica Tabor,
- Adriana Teixeira Rodrigues,
- Justin Qi Yuee Wang,
- Niranjan Kissoon,
- Yemisi Takwoingi,
- Matthew O. Wiens,
- Matthew O. Wiens,
- Adnan Bhutta
Affiliations
- Teresa B. Kortz
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Teresa B. Kortz
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
- Rishi P. Mediratta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Audrey M. Smith
- Department of Medicine, Miller School of Medicine, Miami, FL, United States
- Katie R. Nielsen
- Department of Pediatrics and Department of Global Health, University of Washington, Seattle, WA, United States
- Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Stephanie Gordon Rivera
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
- Hailey Reeves
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Nicole F. O’Brien
- Department of Pediatrics, Ohio State University/Nationwide Children’s Hospital, Columbus, OH, United States
- Jan Hau Lee
- Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
- Jan Hau Lee
- 0Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Qalab Abbas
- 1Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University, Karachi, Pakistan
- Jonah E. Attebery
- 2Department of Pediatrics, University of Colorado, Aurora, CO, United States
- Jonah E. Attebery
- 3Barrow Global Health, Barrow Neurological Institute, Phoenix, AZ, United States
- Tigist Bacha
- 4Department of Pediatric and Child Health, Saint Paul Hospital Medical College, Addis Ababa, Ethiopia
- Emaan G. Bhutta
- 5Mailman School of Public Health, Columbia University, New York, NY, United States
- Carter J. Biewen
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Jhon Camacho-Cruz
- 6Department of Pediatrics, Universidad Nacional de Colombia, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de Bogota-Hospital San José, Fundación Universitaria Sanitas, Clínica Reina Sofia Pediátrica y Mujer Colsanitas, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Bogotá D.C.,Colombia
- Alvaro Coronado Muñoz
- 7Pediatric Critical Care Division, Department of Pediatrics, Children’s Hospital at Montefiore, New York, NY, United States
- Mary L. deAlmeida
- 8Department of Pediatrics, Emory University, Atlanta, GA, United States
- Larko Domeryo Owusu
- 9Pediatric Emergency Unit, Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Yudy Fonseca
- 0Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, United States
- Shubhada Hooli
- 1Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Hunter Wynkoop
- Department of Pediatrics, Ohio State University/Nationwide Children’s Hospital, Columbus, OH, United States
- Mara Leimanis-Laurens
- 2Department of Pediatrics and Human Development, Michigan State University, East Lansing and Helen DeVos Children’s Hospital, Grand Rapids, MI, United States
- Deogratius Nicholaus Mally
- 3Pediatric Intensive Care Unit, Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Amanda M. McCarthy
- 4Department of Pediatrics, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
- Andrew Mutekanga
- 5Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Carol Pineda
- 6Department of Pediatrics, Baystate Medical Center, University of Massachusetts Chan Medical School, Springfield, MA, United States
- Kenneth E. Remy
- 7Department of Pediatrics, Rainbow Babies and Children’s Hospital, and Department of Internal Medicine, University Hospitals of Cleveland, Cleveland, OH, United States
- Sara C. Sanders
- 8Department of Pediatrics, Connecticut Children’s and University of Connecticut, Hartford, CT, United States
- Erica Tabor
- 9Department of Biology, Pennsylvania State University, University Park, PA, United States
- Adriana Teixeira Rodrigues
- 0Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Justin Qi Yuee Wang
- 1Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
- Niranjan Kissoon
- 2Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Yemisi Takwoingi
- 3Institute of Applied Health Research, University of Birmingham, Edgbaston and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
- Matthew O. Wiens
- 4Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Matthew O. Wiens
- 5Walimu, Kampala, Uganda
- Adnan Bhutta
- 6Department of Pediatrics, Indiana University School of Medicine and Riley Children’s Health, Indianapolis, IN, United States
- DOI
- https://doi.org/10.3389/fped.2024.1397232
- Journal volume & issue
-
Vol. 12
Abstract
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.
Keywords
- global health
- resource-limited settings
- low- and middle-income countries
- hospital death
- hospital admission
- acute illness