Identifying areas for quality improvement of pediatric emergency and critical care in Pakistan

Over 6 million children and adolescents die each year, largely in low- and middle-income countries, due to preventable causes. Pakistan is a middle-income country with among the highest number of child and adolescent deaths worldwide. Community prevention strategies, such as sanitation and vaccination campaigns, have dramatically improved child health and survival in Pakistan. However, children continue to develop severe illness due to infectious diseases, injuries and chronic conditions. High-quality emergency hospital services are needed to improve survival for children with these conditions. Challenges to providing essential care include poorly functioning triage systems, insufficient trained personnel, and lack of functional medical equipment and medications. In 2020, the COVID-19 pandemic may place additional strain on the health status of children in Pakistan due to threats to food security, increased poverty, lack of access to primary healthcare and fear of contracting the virus by visiting the hospital. Hospital resources may be overwhelmed by the number of sick adults, detracting from routine and emergency care for children. This project aims to describe causes and rates of death among children and adolescents (0 to 14 years) presenting to district healthcare services prior to and following the onset of the COVID-19 pandemic in March 2020. We will use patient registry data and routine community follow-up to identify risk factors for child death that may be mitigated by improved quality of hospital care. This research will inform subsequent hospital-based care improvement initiatives in Pakistan that are contextualized to the current conditions of the COVID-19 pandemic.