{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:38:30Z","timestamp":1776271110753,"version":"3.50.1"},"reference-count":29,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: Children born in low\u2011 and middle\u2011income countries are 14 times more likely to die before reaching the age of five compared to children in high\u2011income 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.\nObjectives: 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.\nMethod: A retrospective, cross\u2011sectional 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.\nFindings: 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.\nConclusions: 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.<\/jats:p>","DOI":"10.5334\/aogh.4714","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T12:14:34Z","timestamp":1755692074000},"page":"48","source":"Crossref","is-referenced-by-count":1,"title":["Resource Allocation in the Pediatric Intensive Care Unit in Rwanda"],"prefix":"10.5334","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8363-9330","authenticated-orcid":false,"given":"Tracy","family":"Kelly","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen","family":"Selden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dazhanae","family":"Houston","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Meyers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenna","family":"Kent","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6926-6742","authenticated-orcid":false,"given":"Aimable","family":"Kanyamuhunga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3285","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"key20250820121425_r1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3389\/fped.2018.00049","article-title":"Pediatric critical care in resource\u2011limited settings: Overview and lessons learned","volume":"6","year":"2018","journal-title":"Front Pediatr"},{"key":"key20250820121425_r2","unstructured":"UNIGME. Levels & trends in child mortality: Report 2022, estimates developed by the United Nations Inter\u2011agency Group for Child Mortality Estimation (UNIGME). 2023. https:\/\/childmortality.org\/wp-content\/uploads\/2023\/01\/UN-IGME-Child-Mortality-Report-2022.pdf"},{"issue":"11","key":"key20250820121425_r3","first-page":"1191","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"GBD 2016 Lower Respiratory Infections Collaborators","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"key20250820121425_r4","first-page":"513","article-title":"The impact of resource limitations on care delivery and outcomes: Routine variation, the coronavirus disease 2019 pandemic, and persistent shortage","volume":"27","year":"2021","journal-title":"Curr Opin Crit Care"},{"issue":"4","key":"key20250820121425_r5","doi-asserted-by":"crossref","first-page":"e986","DOI":"10.1542\/peds.2010-3657","article-title":"Challenges in setting up pediatric and neonatal intensive care units in a resource\u2011limited country","volume":"128","year":"2011","journal-title":"Pediatrics"},{"issue":"1","key":"key20250820121425_r6","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1186\/s12884-020-03389-7","article-title":"Influencing factors for prevention of postpartum hemorrhage and early detection of childbearing women at risk in Northern Province of Rwanda: Beneficiary and health worker perspectives","volume":"20","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"key20250820121425_r7","first-page":"497","article-title":"Admission pattern and treatment outcome in pediatric intensive care unit, tertiary hospital, Addis Ababa, Ethiopia","volume":"32","year":"2022","journal-title":"Ethiop J Health Sci"},{"issue":"1","key":"key20250820121425_r8","first-page":"60","article-title":"Lessons from the design and implementation of a pediatric critical care and emergency medicine training program in a low resource country: The South American experience","volume":"6","year":"2017","journal-title":"J Pediatr Intensive Care"},{"issue":"8","key":"key20250820121425_r9","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/CCM.0000000000003863","article-title":"Growth and changing characteristics of pediatric intensive care 2001\u20132016","volume":"47","year":"2019","journal-title":"Crit Care Med"},{"issue":"2","key":"key20250820121425_r10","first-page":"109","article-title":"Predictors of mortality in a paediatric intensive care unit in Kigali, Rwanda","volume":"37","year":"2016","journal-title":"Paediatr Int Child Health"},{"issue":"6","key":"key20250820121425_r11","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1093\/tropej\/fmaa025","article-title":"Outcomes following intensive care unit admission in a pediatric cohort in Malawi","volume":"66","year":"2020","journal-title":"J Trop Pediatr"},{"key":"key20250820121425_r12","first-page":"410","article-title":"Scoping review of pediatric early warning systems (PEWS) in resource\u2011limited and humanitarian settings","volume":"6","year":"2018","journal-title":"Front Pediatr"},{"issue":"5","key":"key20250820121425_r13","doi-asserted-by":"crossref","first-page":"e20183657","DOI":"10.1542\/peds.2018-3657","article-title":"Provisional validation of a pediatric early warning score for resource\u2011limited settings","volume":"143","year":"2019","journal-title":"Pediatrics"},{"issue":"6","key":"key20250820121425_r14","doi-asserted-by":"crossref","first-page":"e0270253","DOI":"10.1371\/journal.pone.0270253","article-title":"The impact of pediatric early warning score and rapid response algorithm training and implementation on interprofessional collaboration in a resource\u2011limited setting","volume":"17","year":"2022","journal-title":"PLoS One"},{"issue":"9","key":"key20250820121425_r15","doi-asserted-by":"crossref","first-page":"e075117","DOI":"10.1136\/bmjopen-2023-075117","article-title":"Barriers to equitable access to quality trauma care in Rwanda: A qualitative study","volume":"13","year":"2023","journal-title":"BMJ Open"},{"key":"key20250820121425_r16","unstructured":"Rwanda Social Security Board. 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