PP334 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: COUNTRY SOCIODEMOGRAPHIC LEVEL AND PEDIATRIC CAUSE-SPECIFIC HOSPITAL CASE FATALITY RATES IN LOW- AND MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Aims & Objectives: In 2019, 80% of child deaths were in low- and middle-income countries (LMICs). LMICs have a range of available resources, which could influence outcomes. This analysis determined case-fatality rates (CFRs) for common causes of pediatric hospital mortality in LMICs and explored differences by sociodemographic index (SDI). Methods: For this systematic review, we searched MEDLINE, EMBASE, CINAHL, and LILACS for observational studies from LMICs published 1/1/2005-2/26/2021. Eligible studies included a general pediatric (aged >28d-12yrs) hospital population. We performed meta-analyses of cause of mortality (number of deaths/1000 admissions) and CFRs (number of deaths/total cases) using random-effects models, analyzed differences by SDI, and report 95% confidence intervals (95%CI) and p-values (p<0.05 statistically significant). Results: Overall, 253 studies representing 21.8million hospitalizations, 293 sites, and 59 LMICs were analyzed. Top causes of hospital mortality and CFRs are shown; CFR improved as SDI increased for malaria, pneumonia, and sepsis (Table). Common causes of hospital mortality (per 1000 admissions) and cause-specific CFR by SDI - Mortality(95%CI) CFR(95%CI)* Diagnosis Overall Low-SDI Low-Middle-SDI Middle-SDI p-value Malaria 12.8(9.7-16.2) 5.1(3.7-6.6) 6.9(4.3-9.9) 3.5(2.3-4.9) 1.3(0.8-1.9) <0.0001 Shock 11.6(4.3-22.4) 12.9(9.8-16.3) NR 12.9(9.8-16.3) NR - Malnutrition 9.4(6.3-13.0) 12.2(9.4-15.4) 11.6(7.3-16.7) 12.8(8.8-17.3) 12.9(9.4-17.3) 0.92 Pneumonia 7.9(3.6-13.9) 4.8(1.7-9.3) 6.2(0.3-18.3) 5.5(3.6-7.7) 1.0(0.5-1.6) <0.0001 Sepsis 4.8(3.1-6.7) 19.9(13.6-26.9) 18.0(11.5-25.4) 23.3(17.5-29.7) 8.6(0.6-22.8) 0.14 NR:not reported *pooled estimates Conclusions: Lower SDI countries had a higher risk of death for common diagnoses, suggesting that resource availability and access to care, including critical care, impact pediatric hospital outcomes. Global collaboration is needed for knowledge exchange, best practices development, and resource investments to address child health disparities. Keywords: Resource-limited settings, low- and middle-income countries, global health, acute critical illness,
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.008 |
| Bibliometrics | 0.005 | 0.008 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.031 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".