Download PDF
J Pediatr Intensive Care 2017; 06(01): 006-011
DOI: 10.1055/s-0036-1584672
Review article
Georg Thieme Verlag KG Stuttgart · New York

The Assessment, Evaluation, and Management of the Critically Ill Child When Resources are Limited—Southeast Asian Perspective

Swee Fong Tang
1   Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
,
Lucy Lum
2   Department of Paediatrics, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
› Author Affiliations
Further Information

Publication History

15 June 2015

16 February 2016

Publication Date:
20 June 2016 (online)

    Permissions and Reprints

Abstract

The Southeast Asia region comprises 10 independent countries with highly divergent health systems and health status. The heterogeneity in infant and child mortality rates suggests that there is still scope for improvement in the care of critically ill children. There is, however, a paucity of published data on outcomes and processes of care that could affect planning and implementation of intervention programs. Significant challenges in the delivery of care for the critically ill child remain, especially in pre-hospital and in-hospital triaging and emergency care and inpatient hospital care. Potential areas for continued improvement include strengthening of health systems through sustained commitment by local governments, capacity building, and sharing of research output. Simple, low cost, locally available, and effective solutions should be sought. The introduction of standards and auditing tools can assist in determining effectiveness and outcomes of intervention packages that are adapted to local settings. Recognition and acknowledgment of shortfalls between expectations and outcomes is a first step to overcoming some of these obstacles necessary to achieve a seamless interface among pre-hospital, emergency, inpatient, and critical care delivery processes that would improve survival of critically ill children in this region.

Keywords

critically ill - children - Southeast Asia
 

  • References

  • 1 Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year?. Lancet 2003; 361 (9376): 2226-2234
    CrossrefPubMedGoogle Scholar
  • 2 GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386 (9995): 743-800
    CrossrefPubMedGoogle Scholar
  • 3 Dünser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med 2006; 34 (04) 1234-1242
    CrossrefPubMedGoogle Scholar
  • 4 Chongsuvivatwong V, Phua KH, Yap MT. , et al. Health and health-care systems in southeast Asia: diversity and transitions. Lancet 2011; 377 (9763): 429-437
    CrossrefPubMedGoogle Scholar
  • 5 Kanchanachitra C, Lindelow M, Johnston T. , et al. Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services. Lancet 2011; 377 (9767): 769-781
    CrossrefPubMedGoogle Scholar
  • 6 World Health Organization. World Health Statistics 2015. Geneva: World Health Organization; 2015
    Google Scholar
  • 7 Pasricha SR, Biggs BA. Undernutrition among children in South and South-East Asia. J Paediatr Child Health 2010; 46 (09) 497-503
    CrossrefPubMedGoogle Scholar
  • 8 Black RE, Cousens S, Johnson HL. , et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010; 375 (9730): 1969-1987
    CrossrefPubMedGoogle Scholar
  • 9 Coker RJ, Hunter BM, Rudge JW, Liverani M, Hanvoravongchai P. Emerging infectious diseases in southeast Asia: regional challenges to control. Lancet 2011; 377 (9765): 599-609
    CrossrefPubMedGoogle Scholar
  • 10 World Health Organization. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: World Health Organization; 2009
    Google Scholar
  • 11 World Health Organization. Multidrug and Extensively Drug Resistant TB (M/XDR-TB): Global Report on Surveillance and Response. Geneva, Switzerland: World Health Organization; 2010
    Google Scholar
  • 12 Dondorp AM, Yeung S, White L. , et al. Artemisinin resistance: current status and scenarios for containment. Nat Rev Microbiol 2010; 8 (04) 272-280
    CrossrefPubMedGoogle Scholar
  • 13 Razzak JA, Kellermann AL. Emergency medical care in developing countries: is it worthwhile?. Bull World Health Organ 2002; 80 (11) 900-905
    PubMedGoogle Scholar
  • 14 World Health Organization. The World Health Report 2000. Health Systems: Improving Performance. Geneva, Switzerland: World Health Organization; 2000
    Google Scholar
  • 15 Nolan T, Angos P, Cunha AJLA. , et al. Quality of hospital care for seriously ill children in less-developed countries. Lancet 2001; 357 (9250): 106-110
    CrossrefPubMedGoogle Scholar
  • 16 World Health Organization. Integrated management of childhood illness (IMCI). Geneva: WHO; 2013. Available at: http://www.who.iint/maternal_child_ adolescent/topics/child/imci/en/ . Accessed May 25, 2015
    PubMedGoogle Scholar
  • 17 The World Bank. World Development Report 1993: Investing in Health. New York: Oxford University Press; 1993. . Available at: https://openknowledge.worldbank.org/handle/10986/5976
    Google Scholar
  • 18 Rakha MA, Abdelmoneim AN, Farhoud S. , et al. Does implementation of the IMCI strategy have an impact on child mortality? A retrospective analysis of routine data from Egypt. BMJ Open 2013; 3 (01) DOI: 10.1136/bmjopen-2012-001852.
    PubMedGoogle Scholar
  • 19 Arifeen SE, Hoque DM, Akter T. , et al. Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial. Lancet 2009; 374 (9687): 393-403
    CrossrefPubMedGoogle Scholar
  • 20 Armstrong Schellenberg J, Bryce J, de Savigny D. , et al; Tanzania IMCI Multi-Country Evaluation Health Facility Survey Study Group. The effect of Integrated Management of Childhood Illness on observed quality of care of under-fives in rural Tanzania. Health Policy Plan 2004; 19 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 21 World Health Organization. Integrated Management of Childhood Illness (IMCI) Implementation in the Western Pacific Region: IMCI and Child Survival. Western Pacific Region: World Health Organization; 2011
    Google Scholar
  • 22 World Health Organization. Implementation status of newborn and child health interventions in South-East Asia Region; 2011. Available at: http://www.sear.who.int/entity/child_adolescent/topics/child_health/current_program_staff/ . Accessed June 4, 2015
    PubMedGoogle Scholar
  • 23 Molyneux E. Paediatric emergency care in developing countries. Lancet 2001; 357 (9250): 86-87
    CrossrefPubMedGoogle Scholar
  • 24 Titaley CR, Jusril H, Ariawan I, Soeharno N, Setiawan T, Weber MW. Challenges to the implementation of the integrated management of childhood illness (IMCI) at community centres in West Java province, Indonesia. WHO South-East Asia J Pubic Health 2014; 3 (02) 161-170
    PubMedGoogle Scholar
  • 25 Simoes EAF, Desta T, Tessema T, Gerbresellassie T, Dagnew M, Gove S. Performance of health workers after training in integrated management of childhood illness in Gondar, Ethiopia. Bull World Health Organ 1997; 75 (Suppl. 01) 43-53
    PubMedGoogle Scholar
  • 26 Kalter HD, Schillinger JA, Hossain M. , et al. Identifying sick children requiring referral to hospital in Bangladesh. Bull World Health Organ 1997; 75 (Suppl. 01) 65-75
    PubMedGoogle Scholar
  • 27 Sidik NA, Lazuardi L, Agung FH. , et al; Indonesian Paediatric Hospital Assessment Group. Assessment of the quality of hospital care for children in Indonesia. Trop Med Int Health 2013; 18 (04) 407-415
    CrossrefPubMedGoogle Scholar
  • 28 World Health Organization. Pocket Book of Hospital Care for Children. 2nd ed. World Health Organization Press; 2013
    Google Scholar
  • 29 Gove S, Tamburlini G, Molyneux E, Whitesell P, Campbell H. Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project. Arch Dis Child 1999; 81 (06) 473-477
    CrossrefPubMedGoogle Scholar
  • 30 Tamburlini G, Di Mario S, Maggi RS, Vilarim JN, Gove S. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child 1999; 81 (06) 478-482
    CrossrefPubMedGoogle Scholar
  • 31 Duke T, Keshishiyan E, Kuttumuratova A. , et al. Quality of hospital care for children in Kazakhstan, Republic of Moldova, and Russia: systematic observational assessment. Lancet 2006; 367 (9514): 919-925
    CrossrefPubMedGoogle Scholar
  • 32 Davies K, Sophat A. A positive outcome. Lancet 2004; 364 (9435): 663-664
    PubMedGoogle Scholar
  • 33 World Health Organization. Child and Adolescent Health Progress Report 2004. Geneva: World Health Organization; 2005
    Google Scholar
  • 34 Maclennan C, von Xylander S, Weber MW. Improving the quality of emergency care for children in developing countries. Bull World Health Organ 2006; 84 (04) 258 . Doi: 10.1590/S0042-96862006000400002
    PubMedGoogle Scholar
  • 35 Duncan H, Hutchison J, Parshuram CS. The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care 2006; 21 (03) 271-278
    CrossrefPubMedGoogle Scholar
  • 36 Duncan HP. Survey of early identification systems to identify inpatient children at risk of physiological deterioration. Arch Dis Child 2007; 92 (09) 828 . Doi: 10.1136/adc.2006.112094
    PubMedGoogle Scholar
  • 37 Olson D, Davis NL, Milazi R. , et al. Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource-constrained hospitals in developing countries. Trop Med Int Health 2013; 18 (07) 871-878
    CrossrefPubMedGoogle Scholar
  • 38 Dellinger RP, Levy MM, Rhodes A. , et al; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013; 41 (02) 580-637
    CrossrefPubMedGoogle Scholar
  • 39 Singhi S. Pediatric intensive care—pediatrics for the new millennium. Indian J Pediatr 2001; 68 (03) 247-248
    CrossrefPubMedGoogle Scholar
  • 40 Wills BA, Nguyen MD, Ha TL. , et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med 2005; 353 (09) 877-889
    CrossrefPubMedGoogle Scholar
  • 41 Maitland K, Pamba A, English M. , et al. Randomized trial of volume expansion with albumin or saline in children with severe malaria: preliminary evidence of albumin benefit. Clin Infect Dis 2005; 40 (04) 538-545
    CrossrefPubMedGoogle Scholar
  • 42 Khilnani P, Singhi S, Lodha R. , et al. Pediatric sepsis guidelines: summary for resource-limited countries. Indian J Crit Care Med 2010; 14 (01) 41-52
    CrossrefPubMedGoogle Scholar
  • 43 Allegranzi B, Bagheri Nejad S, Combescure C. , et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377 (9761): 228-241
    CrossrefPubMedGoogle Scholar
  • 44 World Health Organization. The burden of healthcare-associated infection. Worldwide, a summary. Available at: http://www.who.int/gpsc/country_work/summary20100430em.pdf . Accessed June 15, 2015
    PubMedGoogle Scholar
  • 45 Ralston ME, Day LT, Slusher TM, Musa NL, Doss HS. Global paediatric advanced life support: improving child survival in limited-resource settings. Lancet 2013; 381 (9862): 256-265
    CrossrefPubMedGoogle Scholar
  • 46 Lam PK, Tam DTH, Diet TV. , et al. Clinical characteristics of Dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital. Clin Infect Dis 2013; 57 (11) 1577-1586
    CrossrefPubMedGoogle Scholar
  • 47 World Health Organization. Regional Workshop to Improve Inpatient Hospital Care of Children in South-East Asia. World Health Organization Press; 2008
    Google Scholar
  • 48 Global Forum for Health Research. Equitable Access: Research Challenges for Health in Developing Countries. Geneva: Global Forum for Health Research; 2008
    Google Scholar
  • 49 Angell M. The ethics of clinical research in the Third World. N Engl J Med 1997; 337 (12) 847-849
    CrossrefPubMedGoogle Scholar
  • 50 Laman M, Pomat W, Siba P, Betuela I. Ethical challenges in integrating patient-care with clinical research in a resource-limited setting: perspectives from Papua New Guinea. BMC Med Ethics 2013; 14: 29 . Doi: 10.1186/1472-6939-14-29
    CrossrefPubMedGoogle Scholar