Challenges and Priorities for Pediatric Critical Care Clinician-Researchers in Low- and Middle-Income Countries

Abstract

IntroductionThere is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high.Materials and methodsTo inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis.ResultsThe majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation.ConclusionLMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success.

A comparison between raw and predicted mortality in a paediatric intensive care unit in South Africa

“…Paediatric intensive care units (PICUs) are a scarce resource in low and middle income countries (LMICS), particularly sub-Saharan Africa. The majority of deaths in children below 5 years of age occur in LMICS, yet health care resources and per capita health care expenditure are greater in high income countries (HIC) [ 1 – 3 ]. South Africa is a middle income country with limited resources and a shortage of ICU beds.…”

Ethical dilemmas in paediatric intensive care in the South African public healthcare sector

“…Critical care guidelines should not be translated from HICs to LMICs; instead, there is a need for good-quality research from LMICs to inform health policies and develop guidelines appropriate for local resources and spectrums of disease. [19] The ethical framework for these guidelines should also be appropriate for the LMICs context. Moreover, while principlism is readily understood by medical practitioners because it lends itself easily to an empirical approach, other ethical frameworks such as the ethics of caring, and ubuntu, may be preferable in the diverse contexts of SA.…”

Consideraciones geográficas en la interpretación de los resultados de revisiones sistemáticas y meta-análisis: fluidos en sepsis pediátrica

“…Se puede argumentar que la investigación en LMIC es muy escasa, casi ausente, y la calidad de los estudios es baja. Reconocemos que existen muchas limitaciones para la investigación en regiones no desarrolladas 8 . Pero en estas mismas limitaciones radican muchos de los problemas responsables de la alta tasa de mortalidad infantil en estas áreas geográficas.…”

“…Los LMIC estuvieron subrepresentados en esta revisión sistemática 6 . Desafortunadamente, esto es muy frecuente en la mayoría de los consensos, guías clínicas e incluso artículos que tratan sobre la salud global y la agenda de LMIC 8,12,13 .…”