Important Pediatric Conditions in Low- and Middle-Income Countries: A Clinician and Data-Driven Approach

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Background: Emergency care sensitive conditions are defined as those for which rapid diagnosis and early intervention improve patient outcomes. This thesis aimed to develop a list of important pediatric conditions in low- and middle-income countries (LMIC) to be used for further studies on pediatric epidemiology and resource utilization. Methods: A survey of 79 conditions was sent to LMIC physicians, who rated each condition on three categories (time sensitivity, preventability, and commonality) on a scale of 1-9. Responses were matched to Brazil pediatric hospitalization, ambulatory, and mortality data from 2015-2020. Results: 17 physicians completed the first Round of the survey, and 3 of these (17.65%) completed the second Round. Overall, 67 of the 79 (84.21%) were rated as highly time-sensitive and 26 (32.91%) highly preventable. Survey conditions with the highest ratings overall or country overlap (n=11), that were country-specific but highly rated in all three categories (n=8), or that comprised ~1%+ of hospitalizations (n=9), ~0.5%+ of ambulatory visits (n=6), and ~0.5%+ of mortality cases (n=8) were combined with the most common acute non-elective causes of hospitalizations (n=7) and mortality (n=9) into a list of 29 consolidated conditions overall (excluding overlap). These 29 accounted for 37.83% of hospitalizations, 8.97% of ambulatory visits, and 29.17% of mortality cases. 31 of the 79 survey conditions were age-specific and 32 context-specific. Conclusions: These 29 should be targeted in future health system utilization and burden studies. The modified Delphi approach is important in reaching provider consensus.






Kozhumam, Arthi Shankar (2022). Important Pediatric Conditions in Low- and Middle-Income Countries: A Clinician and Data-Driven Approach. Master's thesis, Duke University. Retrieved from


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