PICU development

Childhood mortality rate is still high in sub-Saharan Africa. To improve outcome, dedicated paediatric critical care units are slowly starting to emerge. Setting up these units several new challenges occur including training, setting up systems and logistics and development of protocols. Another major challenge is the selection of children that will most benefit, as the number of critically ill patients greatly outweigh the number of beds. Data to guide these decisions are very limited. We studied the characteristics and outcome of patients admitted to the first PICU in Malawi, with the aim to identify potential predictors of mortality in children admitted to PICU in low (middle)-income countries.

Monitoring

Childhood mortality in low income countries (LMIC) has dramatically decreased over the last two decades. In the 1990’s nearly one in five children living in sub-Saharan Africa died before their fifth birthday. The under-five mortality for sub-Saharan Africa has since more than halved and is currently estimated at 7.6%, however it remains eight times higher when compared to high income countries and requires further reduction in the coming decades. The question is of course how to achieve this. So far the largest reduction may have been due to preventive medicine, an area that may still have room for improvement. However, we now may have entered an era where further reduction of mortality should (also) come from improved curative services. Currently we are undertaking a feasibility study addressing a threefold aim to improve a tablet assisted patient monitoring is suitable in low-resource settings. Second, we want to investigate if it we can develop an algorithm to assist clinicians in diagnosing sepsis. Third, we want to assess if this system is practically and economically viable in low-income countries.

Shock

Shock is a common critical illness in children associated with high mortality. Limited prospective data is available on the prevalence, aetiology and outcome of shock in children in low resource settings. This constrains effective treatment strategies and contributes to mortality. We performed several literature and clinical studies was to assess prevalence, characteristics, pathofysiology, outcome and potential risk factors of shock in children admitted to low income settings and specifically in a large tertiary hospital in Blantyre, Malawi.