Multicenter Study

. 2025 Feb;13(2):e212-e221.

doi: 10.1016/S2214-109X(24)00450-9.

Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study

Teresa B Kortz¹, Adrian Holloway², Asya Agulnik³, David He⁴, Stephanie Gordon Rivera⁵, Qalab Abbas⁶, John Adabie Appiah⁷, Anita V Arias⁸, Jonah Attebery⁹, Jhon Camacho-Cruz¹⁰, Paula Caporal¹¹, Karla Emilia de Sa Rodrigues¹², Ericka Fink¹³, Niranjan Kissoon¹⁴, Jan Hau Lee¹⁵, Eliana López-Barón¹⁶, Srinivas Murthy¹⁷, Fiona Muttalib¹⁷, Katie Nielsen¹⁸, Kenneth Remy¹⁹, Firas Sakaan³, Amelie von Saint Andre-von Arnim²⁰, Adriana Teixeira Rodrigues²¹, William Blackwelder²², Matthew O Wiens²³, Adnan Bhutta²⁴; Global PARITY Investigators; Global Health Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Collaborators, Affiliations

Collaborators

Alhassan Abdul-Mumin, Nabisere Allen, Paloma Amarillo, Kokou H Amegan-Aho, Pamela C Arancibia, Fehmina Arif, Liliana Y Arteaga, Jacqueline G Asibey, Nataly Ávila Guerrero, Tigist Bacha, Briam D Beltran Hernandez, Hippolyte Bwiza Muhire, Juan S Calderon-Cardenas, Mariana Lucía Cañete, Dulamragchaa Chimedbazar, Claudia P Curi, Tenywa Emmanuel, Maria L Escobar, Sofia Esposto, Arieth Figueroa Vargas, Ana L Fustiñana, Marina Giulietti, Muhammad Irfan Habib, Pascal Havugarurema, Lucia C Hernandez Somerson, Nayibe Hincapie Saldarriaga, Shubhada Hooli, Jacob Isabirye, Saifullah Jamro, Juan C Jaramillo-Bustamante, Liliana P Jurado Salcedo, Halima Kabir, Caleb K Karanja, Adama Mamby Keita, Marie-Charlyne F Kilba, Guillermo Kohn-Loncarica, Kandamaran Krishnamurthy, Jorhk D Lasso Noguera, Marianne N Majdalani, Isabel C Monje Cardona, Emilse N Montero Nuñez, Celia I Mulgado Aguas, Raya Y Mussa, John H Nebaza, María N Noya, Edna O Obodai, Carmen E Ocampo, Çağlar Ödek, Tagbo Oguonu, Afua K Osew-Gyamfi, Larko D Owusu, Sheila A Owusu, Mayerly M Palencia Bocarejo, Freddy I Pantoja Chamorro, Aurora L Pedroza, Walugembe S Peter, Javier Prego, Amal C Rahi, Carmen R Ramírez Hernández, Pedro Rino, Jhuma Sankar, Hendry R Sawe, Jesus A Serra, Agustin G Shaieb, Arianna McLain Shirk, Enkhtur Shonkhuuz, Javier M Sierra-Abaunza, Khurram Soomro, Samba O Sow, Abner V Tagoola, Atnafu M Tekleab, Margarita M Torres, Christian Umuhoza, Pablo Vasquez-Hoyos, Justin Q Y Wang, Rafiuk C Yakubu, Rita Fosu Yeboah, María P Zamarbide

Affiliations

¹ Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA; Division of Critical Care, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. Electronic address: teresa.kortz@ucsf.edu.
² Department of Pediatrics, University of Maryland, Baltimore, MD, USA.
³ Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
⁴ Analytical Solutions Group, North Potomac, MD, USA.
⁵ Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
⁶ Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University, Karachi, Pakistan.
⁷ Pediatric Intensive Care Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁸ Division of Critical Care and Pulmonary Medicine, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN, USA.
⁹ Department of Pediatrics, Section of Pediatric Critical Care, University of Colorado, Aurora, CO, USA; Barrow Global Health, Barrow Neurological Institute, Phoenix, AZ, USA.
¹⁰ Department of Pediatrics, Universidad Nacional de Colombia, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia; Sociedad de Cirugía de Bogota-Hospital San José, Fundación Universitaria Sanitas, Bogotá, Colombia; Clínica Pediátrica Clínicas Colsanitas, Bogotá, Colombia.
¹¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Red Colaborativa Pediátrica de Latinoamérica (LARed Network), La Plata, Buenos Aires, Argentina.
¹² Pediatric Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
¹³ Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Institute for Global Health, Children's and Women's Hospital, Vancouver, BC, Canada.
¹⁵ Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore; SingHealth Duke-NUS Global Health Institute, Singapore.
¹⁶ Unidad de Cuidado Crítico Pediátrico, Hospital Pablo Tobón Uribe, Medellín, Colombia; Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia.
¹⁷ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹⁸ Division of Pediatric Critical Care, Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
¹⁹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University Hospitals of Cleveland and Rainbow Babies and Children's Hospital, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
²⁰ Department of Global Health, University of Washington, Seattle, WA, USA; Division of Pediatric Critical Care, Department of Pediatrics, University of Washington, Seattle, WA, USA.
²¹ Departamento de Pediatria, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Pediatria, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
²² Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
²³ Institute for Global Health, Children's and Women's Hospital, Vancouver, BC, Canada; Walimu, Kampala, Uganda; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
²⁴ Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

PMID: 39890223
PMCID: PMC12558667
DOI: 10.1016/S2214-109X(24)00450-9

Multicenter Study

Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study

Teresa B Kortz et al. Lancet Glob Health. 2025 Feb.

. 2025 Feb;13(2):e212-e221.

doi: 10.1016/S2214-109X(24)00450-9.

Authors

Collaborators

Alhassan Abdul-Mumin, Nabisere Allen, Paloma Amarillo, Kokou H Amegan-Aho, Pamela C Arancibia, Fehmina Arif, Liliana Y Arteaga, Jacqueline G Asibey, Nataly Ávila Guerrero, Tigist Bacha, Briam D Beltran Hernandez, Hippolyte Bwiza Muhire, Juan S Calderon-Cardenas, Mariana Lucía Cañete, Dulamragchaa Chimedbazar, Claudia P Curi, Tenywa Emmanuel, Maria L Escobar, Sofia Esposto, Arieth Figueroa Vargas, Ana L Fustiñana, Marina Giulietti, Muhammad Irfan Habib, Pascal Havugarurema, Lucia C Hernandez Somerson, Nayibe Hincapie Saldarriaga, Shubhada Hooli, Jacob Isabirye, Saifullah Jamro, Juan C Jaramillo-Bustamante, Liliana P Jurado Salcedo, Halima Kabir, Caleb K Karanja, Adama Mamby Keita, Marie-Charlyne F Kilba, Guillermo Kohn-Loncarica, Kandamaran Krishnamurthy, Jorhk D Lasso Noguera, Marianne N Majdalani, Isabel C Monje Cardona, Emilse N Montero Nuñez, Celia I Mulgado Aguas, Raya Y Mussa, John H Nebaza, María N Noya, Edna O Obodai, Carmen E Ocampo, Çağlar Ödek, Tagbo Oguonu, Afua K Osew-Gyamfi, Larko D Owusu, Sheila A Owusu, Mayerly M Palencia Bocarejo, Freddy I Pantoja Chamorro, Aurora L Pedroza, Walugembe S Peter, Javier Prego, Amal C Rahi, Carmen R Ramírez Hernández, Pedro Rino, Jhuma Sankar, Hendry R Sawe, Jesus A Serra, Agustin G Shaieb, Arianna McLain Shirk, Enkhtur Shonkhuuz, Javier M Sierra-Abaunza, Khurram Soomro, Samba O Sow, Abner V Tagoola, Atnafu M Tekleab, Margarita M Torres, Christian Umuhoza, Pablo Vasquez-Hoyos, Justin Q Y Wang, Rafiuk C Yakubu, Rita Fosu Yeboah, María P Zamarbide

Affiliations

¹ Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA; Division of Critical Care, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. Electronic address: teresa.kortz@ucsf.edu.
² Department of Pediatrics, University of Maryland, Baltimore, MD, USA.
³ Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
⁴ Analytical Solutions Group, North Potomac, MD, USA.
⁵ Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
⁶ Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University, Karachi, Pakistan.
⁷ Pediatric Intensive Care Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁸ Division of Critical Care and Pulmonary Medicine, Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN, USA.
⁹ Department of Pediatrics, Section of Pediatric Critical Care, University of Colorado, Aurora, CO, USA; Barrow Global Health, Barrow Neurological Institute, Phoenix, AZ, USA.
¹⁰ Department of Pediatrics, Universidad Nacional de Colombia, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia; Sociedad de Cirugía de Bogota-Hospital San José, Fundación Universitaria Sanitas, Bogotá, Colombia; Clínica Pediátrica Clínicas Colsanitas, Bogotá, Colombia.
¹¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Red Colaborativa Pediátrica de Latinoamérica (LARed Network), La Plata, Buenos Aires, Argentina.
¹² Pediatric Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
¹³ Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Institute for Global Health, Children's and Women's Hospital, Vancouver, BC, Canada.
¹⁵ Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore; SingHealth Duke-NUS Global Health Institute, Singapore.
¹⁶ Unidad de Cuidado Crítico Pediátrico, Hospital Pablo Tobón Uribe, Medellín, Colombia; Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia.
¹⁷ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹⁸ Division of Pediatric Critical Care, Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
¹⁹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University Hospitals of Cleveland and Rainbow Babies and Children's Hospital, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
²⁰ Department of Global Health, University of Washington, Seattle, WA, USA; Division of Pediatric Critical Care, Department of Pediatrics, University of Washington, Seattle, WA, USA.
²¹ Departamento de Pediatria, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Pediatria, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
²² Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
²³ Institute for Global Health, Children's and Women's Hospital, Vancouver, BC, Canada; Walimu, Kampala, Uganda; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
²⁴ Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

PMID: 39890223
PMCID: PMC12558667
DOI: 10.1016/S2214-109X(24)00450-9

Abstract

Background: Children in resource-constrained settings (RCS) have disproportionately high illness and mortality; however, the prevalence in RCS of paediatric acute critical illness (P-ACI; life-threatening conditions that require time-sensitive interventions) is unknown. Most P-ACI can be managed with basic critical care (stabilisation, fluid resuscitation, oxygen, and vital-organ support), but RCS hospitals often lack such essential services. This study estimated the prevalence and examined the aetiology of P-ACI among children at RCS hospitals to support critical care capacity building and inform resource allocation.

Methods: We conducted a hybrid prospective cohort and multinational point prevalence study of acutely ill or injured children aged 28 days to 14 years who presented to RCS hospitals on four designated days between July 20, 2021, and July 12, 2022. We measured the proportion of participants with P-ACI, applying the definition for acute paediatric critical illness (DEFCRIT) framework for research in resource-variable settings, and followed up admitted patients for hospital outcomes. In participants with P-ACI, we report diagnoses associated with critical illness. We used descriptive statistics to summarise site and cohort data by country sociodemographic category (Socio-demographic Index; SDI) and multivariable logistic regression to assess whether country sociodemographic category was independently associated with P-ACI.

Findings: The study included 46 sites, 19 countries, and 7538 children, among whom 2651 (35·2%) were admitted to hospital and 68 died (all-cause mortality 0·9% [95% CI 0·7-1·1]). 985 (13·1% [95% CI 12·3-13·9]) participants had P-ACI. Among all sociodemographic categories, P-ACI prevalence was highest (28·0% [26·0-30·1]; 512 of 1828 participants) in low-SDI countries (p<0·0001). Mortality among those with P-ACI was 6·3% (4·9-8·0; 62 deaths). The most common P-ACI diagnoses were pneumonia (152 [15·4%] of 985 participants), sepsis or septic shock (102 [10·4%]), and malaria (95 [9·6%]). In an adjusted model, country sociodemographic category was not significantly associated with P-ACI frequency. Among all 68 deaths in the study, 40 (59% [46-71]) occurred within 48 h of presentation.

Interpretation: P-ACI in RCS hospitals is common, associated with high mortality, disproportionately elevated in low-SDI countries, and associated with conditions that can be managed with basic critical care. This study underlines the need for investment in basic critical care services in RCS to address a major contributor to preventable mortality in hospitalised children.

Funding: National Institutes of Health (USA); Medical Research Council (Singapore); Grand Challenges Canada; and University of Maryland, Baltimore (USA).

Translations: For the French, Portuguese and Spanish translations of the abstract see Supplementary Materials section.

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Conflict of interest statement

Declaration of interests AB has received support from the University of Maryland Baltimore President's Global Impact Funds. WB has received consulting fees from the University of Maryland School of Medicine. JC-C has been a speaker for Novamed and Tecnoquimicas; has received financial travel support from BAGO to attend the Colombian Congress of Pediatrics; has participated on an advisory board for Zambon Colombia; and has acted as an investigator in phase 2 and 3 clinical trials of Merck Sharp and Dohme drugs (antibiotics and monoclonal antibodies), outside of the course of this study. DH has received consulting fees from the University of Maryland School of Medicine. JHL has received support from the National Research Medical Council, Singapore (MOH-TA19nov-001) and from the Thrasher Foundation, USA. All other authors declare no competing interests. The Global PARITY Investigators’ interests are provided in appendix 4 (p 94).

Figures

**Figure 1:. Screening, participant enrolment, and outcomes by P-ACI status**
P-ACI=paediatric acute critical illness.

**Figure 2:. Prevalence of P-ACI and mortality among acutely ill or injured children presenting to a resource-constrained hospital, by country sociodemographic category**
Country sociodemographic category was based on SDI quintile. Note that scales differ between the left axis (prevalence of P-ACI) and right axis (mortality). Error bars are 95% CIs. Significant differences were identified in the prevalence of P-ACI and mortality by sociodemographic category. P-ACI=paediatric acute critical illness. SDI=Socio-demographic Index.

**Figure 3:. Diagnoses among paediatric patients with P-ACI in the overall cohort and by country sociodemographic category**
Country sociodemographic category was based on SDI quintile. The most common diagnoses associated with P-ACI are shown. Numbers in individual cells represent the ranking of the specified diagnosis, where 1 is the most common (darker shading). Grey shading indicates rankings outside of the top 10 overall diagnoses. Numbers and percentages of patients with each diagnosis in the overall cohort are provided in appendix 4 (p 82). P-ACI=paediatric acute critical illness. SDI=Socio-demographic Index.

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Comment in

Climate change and NTDs: a perfect storm.
The Lancet Global Health. The Lancet Global Health. Lancet Glob Health. 2025 Feb;13(2):e172. doi: 10.1016/S2214-109X(25)00014-2. Lancet Glob Health. 2025. PMID: 39890211 No abstract available.

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Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study

Collaborators

Affiliations

Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study

Authors

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Affiliations

Abstract

Conflict of interest statement

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