J Pediatr Intensive Care 2017; 06(01): 066-076
DOI: 10.1055/s-0036-1584677
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Assessment, Evaluation, and Management of the Critically Ill Child in Resource-Limited International Settings

Tina Slusher
1   Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
2   Department of Pediatrics, Hennepin County Medical School, Minneapolis, Minnesota, United States
Ashley Bjorklund
1   Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
Hellen T. Aanyu
3   Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda
Andrew Kiragu
1   Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
2   Department of Pediatrics, Hennepin County Medical School, Minneapolis, Minnesota, United States
Christo Philip
4   Department of Emergency and Intensive Care, Duncan Hospital, Raxaul, Bihar, India
› Author Affiliations
Further Information

Publication History

05 June 2015

22 March 2016

Publication Date:
29 June 2016 (online)


Providing evidence-based care to the critically ill child including assessment, evaluation, and management in resource-limited settings provides unique challenges and limitless opportunities to significantly impact morbidity and mortality in these settings. Difficulties encountered include: determining which disease processes will benefit most from critical care in resource-limited settings, lack of triage tools and adjuncts to help with assessment, finite laboratory and radiological tests, limited understanding of key findings in critically ill/injured pediatric patients, (especially by those without pediatric focused training), and finally, lack of supplies, medicines, equipment, and training of health care providers to appropriately treat critically ill children in these resource-limited settings. In this review, the most common problems encountered and possible solutions to overcome these obstacles are discussed.

  • References

  • 1 Mathers C, Fat DM, Boerma JT. , World Health Organization. The Global Burden of Disease: 2004 Update. Geneva, Switzerland: World Health Organization; 2008
  • 2 Murthy S, Adhikari NK. Global health care of the critically ill in low-resource settings. Ann Am Thorac Soc 2013; 10 (05) 509-513
  • 3 He S, Lunnen JC, Puvanachandra P, , Amar-Singh, Zia N, Hyder AA. Global childhood unintentional injury study: multisite surveillance data. Am J Public Health 2014; 104 (03) e79-e84
  • 4 Abdur-Rahman LO, van As ABS, Rode H. Pediatric trauma care in Africa: the evolution and challenges. Semin Pediatr Surg 2012; 21 (02) 111-115
  • 5 Acharya SP. Critical care medicine in Nepal: where are we?. In Health 2013; 5 (02) 92-95
  • 6 Ward NS, Teno JM, Curtis JR, Rubenfeld GD, Levy MM. Perceptions of cost constraints, resource limitations, and rationing in United States intensive care units: results of a national survey. Crit Care Med 2008; 36 (02) 471-476
  • 7 Argent AC. Managing HIV in the PICU—the experience at the Red Cross War Memorial Children's Hospital in Cape Town. Indian J Pediatr 2008; 75 (06) 615-620
  • 8 Emergency Medicine Society of South Africa—Practice Guideline EM 014—Implementation of the South African Triage Scale. Available at: http://emssa.org.za/documents/em014.pdf . Accessed May 25, 2015
  • 9 Molyneux E, Ahmad S, Robertson A. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ 2006; 84 (04) 314-319
  • 10 Bateman C. New triage system halves mortalities. S Afr Med J 2006; 96 (09) 770-772
  • 11 Maitland K, Kiguli S, Opoka RO. , et al; FEAST Trial Group. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011; 364 (26) 2483-2495
  • 12 Jacob ST, Lim M, Banura P. , et al. Integrating sepsis management recommendations into clinical care guidelines for district hospitals in resource-limited settings: the necessity to augment new guidelines with future research. BMC Med 2013; 11: 107 . Doi: 10.1186/1472-6939-14-29
  • 13 World Health Organization. IMAI District Clinician Manual. Geneva: WHO; 2011
  • 14 Sippel S, Muruganandan K, Levine A, Shah S. Review article: use of ultrasound in the developing world. Int J Emerg Med 2011; 4: 72 . Doi: 10.1186/1865-1380-4-72
  • 15 Iverson K, Haritos D, Thomas R, Kannikeswaran N. The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED. Am J Emerg Med 2012; 30 (08) 1347-1351
  • 16 Argent AC, Ahrens J, Morrow BM. , et al. Pediatric intensive care in South Africa: an account of making optimum use of limited resources at the Red Cross War Memorial Children's Hospital*. Pediatr Crit Care Med 2014; 15 (01) 7-14
  • 17 Dünser MW, Festic E, Dondorp A. , et al; Global Intensive Care Working Group of European Society of Intensive Care Medicine. Recommendations for sepsis management in resource-limited settings. Intensive Care Med 2012; 38 (04) 557-574
  • 18 Jeyarajah R. Russell's viper bite in Sri Lanka. A study of 22 cases. Am J Trop Med Hyg 1984; 33 (03) 506-510
  • 19 Gaus DP, Herrera DF, Troya CJ, Guevara AH. Management of snakebite and systemic envenomation in rural Ecuador using the 20-minute whole blood clotting test. Wilderness Environ Med 2013; 24 (04) 345-350
  • 20 Ministry of Health. Basic Paediatric Protocols. Uganda: Ministry of Health; 2014
  • 21 Peter JV, Moran JL, Graham P. Oxime therapy and outcomes in human organophosphate poisoning: an evaluation using meta-analytic techniques. Crit Care Med 2006; 34 (02) 502-510
  • 22 Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med 1987; 316 (13) 761-763
  • 23 Zar HJ, Brown G, Donson H, Brathwaite N, Mann MD, Weinberg EG. Home-made spacers for bronchodilator therapy in children with acute asthma: a randomised trial. Lancet 1999; 354 (9183): 979-982