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. 2024 Jun 7:12:1397232.
doi: 10.3389/fped.2024.1397232. eCollection 2024.

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis

Teresa B Kortz  1   2 , Rishi P Mediratta  3 , Audrey M Smith  4 , Katie R Nielsen  5 , Asya Agulnik  6 , Stephanie Gordon Rivera  2 , Hailey Reeves  7 , Nicole F O'Brien  8 , Jan Hau Lee  9   10 , Qalab Abbas  11 , Jonah E Attebery  12   13 , Tigist Bacha  14 , Emaan G Bhutta  15 , Carter J Biewen  1 , Jhon Camacho-Cruz  16 , Alvaro Coronado Muñoz  17 , Mary L deAlmeida  18 , Larko Domeryo Owusu  19 , Yudy Fonseca  20 , Shubhada Hooli  21 , Hunter Wynkoop  8 , Mara Leimanis-Laurens  22 , Deogratius Nicholaus Mally  23 , Amanda M McCarthy  24 , Andrew Mutekanga  25 , Carol Pineda  26 , Kenneth E Remy  27 , Sara C Sanders  28 , Erica Tabor  29 , Adriana Teixeira Rodrigues  30 , Justin Qi Yuee Wang  31 , Niranjan Kissoon  32 , Yemisi Takwoingi  33 , Matthew O Wiens  34   35 , Adnan Bhutta  36
Affiliations

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis

Teresa B Kortz et al. Front Pediatr. .

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: acute illness; critical illness; global health; hospital admission; hospital death; low- and middle-income countries; resource-limited settings.

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Conflict of interest statement

JC-C speaker for Novamed and Tecnoquimicas; received financial travel support from BAGO to attend the Colombian Congress of Pediatrics; participated in an Advisory Board for ZambonColombia; acted as an investigator in phase 2 and 3 clinical trials of Merck Sharp and Dhome drugs (antibiotics and monoclonal antibodies) that do not interfere in the course of this study. JL stock options in MERCK and MODERNA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor “CFO” declared a past co-authorship with the authors “NK & MOW”. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Study selection process. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) flowchart for title and abstract screening and text selection from the final search (conducted March 1, 2021).
Figure 2
Figure 2
All-cause pediatric hospital mortality by Global Burden of Disease (GBD) super region. Point estimates and 95% confidence intervals shown. Estimates for Central Europe, Eastern Europe, and Central Asia (CE) are not included given limited data. LA, Latin America and Caribbean; NA, North Africa and Middle East; SA, South Asia; SEA, Southeast Asia, East Asia, and Oceania; SSA, Sub-Saharan Africa.
Figure 3
Figure 3
Common causes of hospital mortality in children by organ system and GBD super region. Organ systems are ordered according to the overall rate (number of children with a cause of death/1,000 children admitted) and the number in parenthesis next to each organ system represents the number of studies included in the analysis. Overall and GBD super region mortality rates are presented as pooled estimates from random-effects models with 95% confidence intervals (CI). Estimates for Central Europe, Eastern Europe, and Central Asia (CE) are not included given limited data. The hematological category includes oncological conditions. The numbers in () next to each category in the left column are the number of studies included in the overall analysis shown on the right. The categories are sorted according to the overall proportion across the super regions. The hematological category includes oncological conditions. LA, Latin America and Caribbean; NA, North Africa and Middle East; SA, South Asia; SEA, Southeast Asia, East Asia, and Oceania; SSA, Sub-Saharan Africa; CI, Confidence Interval; NR, not reported.
Figure 4
Figure 4
Case fatality rates in children admitted to hospital by organ system and Global Burden of Disease (GBD) super region. Organ systems are ordered according to the overall fatality (number of children with a specific cause of death/1,000 children admitted with that cause) and the number in parenthesis next to each organ system represents the number of studies included in the analysis. Overall and GBD super region case fatality rates are presented as pooled estimates from random-effects models with 95% confidence intervals (CI). Estimates for Central Europe, Eastern Europe, and Central Asia (CE) are not included given limited data. The hematological category includes oncological conditions. The numbers in () next to each category in the left column are the number of studies included in the overall analysis shown on the right. The categories are sorted according to the overall proportion across the super regions. The hematological category includes oncological conditions. LA, Latin America and Caribbean; NA, North Africa and Middle East; SA, South Asia; SEA, Southeast Asia, East Asia, and Oceania; SSA, Sub-Saharan Africa; CI, Confidence Interval; NR, not reported.
Figure 5
Figure 5
Common causes of hospital admission in children by organ system and Global Burden of Disease (GBD) super region. Organ systems are ordered according to the overall proportion of children with the cause of admission and the number in parenthesis next to each organ system represent the number of studies included in the analysis. Overall and GBD super region proportions are presented as pooled estimates from random-effects models with 95% confidence intervals (CI). Estimates for Central Europe, Eastern Europe, and Central Asia (CE) are based on a single study of 638 children. The hematological category includes oncological conditions. The numbers in () next to each category in the left column are the number of studies included in the overall analysis shown on the right. The categories are sorted according to the overall proportion across the super regions. The hematological category includes oncological conditions. CE, Central Europe, Eastern Europe, and Central Asia; LA, Latin America and Caribbean; NA, North Africa and Middle East; SA, South Asia; SEA, Southeast Asia, East Asia, and Oceania; SSA, Sub-Saharan Africa; CI, Confidence Interval; NR, not reported.
Figure 6
Figure 6
Actions to address preventable child mortality. This figure illustrates the coordinated global effort across multiple domains (e.g., healthcare quality) and levels (e.g., regional) that is required to address preventable child mortality.
See this image and copyright information in PMC

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