Abstract
There 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. To 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. The 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. LMIC 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.
Highlights
The United Nations established Millennium Development Goal 4 aimed to reduce the under-five mortality rate by 2/3 between 1990 and 2015 based on the United Nations Millennium Declaration [1]
The high burden of child mortality in low- and middle-income countries (LMIC) is egregious considering that many lives could be saved by proven, simple resuscitative, and critical care interventions despite austere environments and fewer pediatric critical care (PCC) resources compared with high-income countries (HIC) [11,12,13,14,15]
We conducted a survey with the following objectives: [1] to assess major challenges and potential solutions to PCC research in LMIC; [2] to foster worldwide research collaborations; and [3] to begin building a global research network to promote high quality research focused on improving outcomes for critically ill children
Summary
The United Nations established Millennium Development Goal 4 aimed to reduce the under-five mortality rate by 2/3 between 1990 and 2015 based on the United Nations Millennium Declaration [1]. Investment in resuscitation and critical care improves patient outcomes in LMIC [6,7,8,9] This health disparity is exacerbated by the “10–90 gap”: only 10% of health-care research expenditures worldwide address diseases that primarily affect the poorest 90% of the world’s population [10]. The World Health Report 2013 called for LMIC to be users, and producers of health research [16] Such health research requires study of leading regional causes of death and disability, which will provide data necessary to inform allocation, determine health-care delivery strategy, and assess quality standards required for effective critical care [15, 20, 21]. We conducted a survey with the following objectives: [1] to assess major challenges and potential solutions to PCC research in LMIC; [2] to foster worldwide research collaborations; and [3] to begin building a global research network to promote high quality research focused on improving outcomes for critically ill children
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