Resource Allocation in the Pediatric Intensive Care Unit in Rwanda.

Abstract

Background: Children born in low‑ and middle‑income countries are 14 times more likely to die before reaching the age of five compared to children in high‑income countries. Pediatric Intensive Care Units (PICUs) with specialized equipment and advanced medications managed by trained clinicians have reduced mortality of children worldwide, yet countries with limited funds and scarce resources strain to meet needs of critically ill children. Objectives: The aim of the study was to identify the disease burden of patients entering the PICU at the Central Hospital in Kigali, Rwanda, and the relationship between patient mortality and allocation of resources. In addition, this study focused on several factors suspected to impact the mortality rate, including the entry point into the health system, delay in admittance, and whether surgery was performed. Method: A retrospective, cross‑sectional review of 30 medical records per year was conducted between January 2016 and December 2022, totaling 177 encounters. Demographic and clinical data were extracted and analyzed to perform descriptive and inferential statistics, including univariable and multivariable logistic regression analyses to identify factors affecting mortality. Findings: The study showed an overall mortality rate of 55% for patients admitted to the PICU. Among patients who died, the most common diagnoses were sepsis, primary respiratory failure, and congenital defects. When holding age and surgery constant, patients with a noted delay in admittance to the PICU had increased odds of mortality than those without a delay. Holding the delay in admittance constant, there was an interaction effect between age and surgery on mortality, with higher odds of mortality in newborns than in children over one month of age when surgery was performed. Conclusions: Careful adherence to emerging pediatric sepsis guidelines, immediate recognition, and appropriate treatment may reduce mortality. Prioritizing policies that reduce delays in treating critically ill children may improve outcomes.