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

Methods

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 2000 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 1000 admissions with 95% confidence intervals (95%CI). Findings: ur 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/1000 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/1000 admissions) were respiratory (255 [95%CI 231-280]); infectious (214 [95%CI193-234]); and gastrointestinal (166 [95%CI 143-190]).

We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Implications: 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. NOTE for restricted files: If you are not yet a CoLab member, please complete our membership application survey to gain access to restricted files within 2 business days. Some files may remain restricted to CoLab members.

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