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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review
Journal of global health, Volume 13, Year 2023
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Description
Background: Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature. Methods: A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020. Results: A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%). Conclusions: This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings. Registration: PROSPERO CRD42019146802. Copyright © 2023 by the Journal of Global Health. All rights reserved.
Authors & Co-Authors
Lim, Andrew George
Unknown Affiliation
Kivlehan, Sean M.
United States, Boston
Brigham and Women's Hospital
United States, Cambridge
Harvard University
Losonczy, Lia Ilona
United States, Washington, D.c.
George Washington University Medical Center
Murthy, Srinivas N.Krishna
Canada, Vancouver
The University of British Columbia
Lowsby, Richard
United Kingdom, Crewe
Mid Cheshire Hospitals Nhs Foundation Trust
Papali, Alfred C.
Unknown Affiliation
Raees, Madiha Q.
United States, Philadelphia
The Children's Hospital of Philadelphia
Seth, Bhavna
United States, Baltimore
Johns Hopkins Medicine
Cobb, Natalie L.
United States, Seattle
University of Washington
Dippenaar, Enrico
South Africa, Cape Town
University of Cape Town
Shrestha, Gentle Sunder
Nepal, Kathmandu
Tribhuvan University Teaching Hospital
Jaung, Michael Senyu
United States, Houston
Baylor College of Medicine
Sefa, Nana
United States, Washington, D.c.
Washington Hospital Center
Benzoni, Nicole S.
Unknown Affiliation
Velasco, Bernadett Pua
Unknown Affiliation
Adhikari, Neill K.J.
Canada, Toronto
University of Toronto
Reynolds, Teri A.
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Authors: 17
Affiliations: 25
Identifiers
Doi:
10.7189/jogh.13.04141
ISSN:
20472986
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Study Approach
Systematic review