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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Emergency care interventions for paediatric severe acute respiratory infections in low and middle-income countries: A systematic review and narrative synthesis
Journal of Global Health, Volume 13, Article 04065, Year 2023
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Description
Background Severe acute respiratory infections (SARIs) are the leading cause of paediatric death globally, particularly in low and middle-income countries (LMICs). Given the potential rapid clinical decompensation and high mortality rate from SARIs, interventions that facilitate the early care are critical to improving patient outcomes. Through this systematic review, we aimed to evaluate the impact of emergency care interventions on improving clinical outcomes of paediatric patients with SARIs in LMICs. Methods We searched PubMed, Global Health, and Global Index Medicus for peer-reviewed clinical trials or studies with comparator groups published before November 2020. We included all studies which evaluated acute and emergency care interventions on clinical outcomes for children (29 days to 19 years) with SARIs conducted in LMICs. Due to observed heterogeneity of interventions and outcomes, we performed narrative synthesis. We assessed bias using the Risk of Bias 2 and Risk of Bias in Non-Randomized Studies of Interventions tools. Results We screened 20 583, 99 of which met the inclusion criteria. Conditions studied included pneumonia or acute lower respiratory infection (61.6%) and bronchiolitis (29.3%). Studies evaluated medications (80.8%), respiratory support (14.1%), and supportive care (5%). We found the strongest evidence of benefit for decreasing risk of death for respiratory support interventions. Results were inconclusive on the utility of continuous positive airway pressure (CPAP). We found mixed results for interventions for bronchiolitis, but a possible benefit for hypertonic nebulised saline to decrease hospital length of stay. Early use of adjuvant treatments such as Vitamin A, D, and zinc for pneumonia and bronchiolitis did not appear to have convincing evidence of benefit on clinical outcomes. Conclusions Despite the high global burden of SARI in paediatric populations, few emergency care (EC) interventions have high quality evidence for benefit on clinical outcomes in LMICs. Respiratory support interventions have the strongest evidence for benefit. Further research on the use of CPAP in diverse settings is needed, as is a stronger evidence base for EC interventions for children with SARI, including metrics on the timing of interventions. © 2023 The Author(s)
Authors & Co-Authors
Relan, Pryanka
United States, Atlanta
Emory Healthcare
Garbern, Stephanie Chow
United States, Providence
Brown University
O’Reilly, Gerard M.
Australia, Clayton
Monash University
Bills, Corey B.
United States, Aurora
University of Colorado School of Medicine
Schultz, Megan L.
United States, Milwaukee
Medical College of Wisconsin
Kivlehan, Sean M.
United States, Boston
Brigham and Women's Hospital
United States, Cambridge
Harvard University
Trehan, Indi
United States, Seattle
University of Washington
Becker, Torben K.
United States, Gainesville
University of Florida
Statistics
Citations: 1
Authors: 8
Affiliations: 9
Identifiers
Doi:
10.7189/JOGH.13.04065
ISSN:
20472978
Research Areas
Genetics And Genomics
Health System And Policy
Maternal And Child Health
Study Design
Quasi Experimental Study
Narrative Study
Study Approach
Qualitative
Systematic review