(786) The Etiology of Hospital Mortality in Children in LMICs: A Systematic Review and Meta-Analysis

Introduction: In 2019, 80% of the 7·4million children who died around the world were in low- and middle-income countries (LMICs). This study aimed to determine global and regional estimates of the common causes of pediatric hospital mortality and admission in LMICs and explore regional differences.

Methods: This systematic review (PROSPERO #230228) searched MEDLINE, EMBASE, CINAHL, and LILACS to identify observational studies from LMICs published January 1, 2005-February 26, 2021. Eligible studies included a general pediatric (aged >28d-12yrs) admission population, cause of admission or death, and total admissions. We excluded studies with data before 2000 or without a full text. Two, independent reviewers screened and extracted data. We performed a meta-analysis of cause-specific mortality, case fatality rates (CFRs), and cause of admission using random-effects models. We reported proportions as cause of death or cause of admission per 1000 admissions with 95% confidence intervals (CI). Heterogeneity was assessed using the variance estimates.

Results: Our search identified 29,637 texts. After duplicate removal, and screening, 257 studies were analysed. 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]). Conditions with the highest CFRs were neurologic (13% [95%CI 9-18%]); cardiovascular (11% [95%CI 6-16%]); and congenital conditions (8% [95%CI 4-12%]). 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]).

Conclusions: Pediatric hospital mortality is high in LMICs and there are significant regional differences in burden of disease. Global child health efforts must include measures to reduce LMIC hospital mortality including basic emergency and critical care services to address common causes of death. A major priority is supporting LMIC researchers to implement and assess these service-related interventions, measure outcomes, and ensure equity and sustainability.