P3.086: Epidemiology and Outcomes of Critical Care Admissions in Kijabe, Kenya

Background: Sub-Saharan Africa carries the highest burden of pediatric critical illness and mortality globally, yet has the lowest number of skilled healthcare providers. The majority of inpatient pediatric mortality in Sub-Saharan Africa occurs within 48-72 hours of presentation, highlighting the need for effective emergency and critical care. PECC-Kenya is a collaboration between the University of Nairobi, Kenyatta National Hospital, the University of Washington and AIC Kijabe Hospital (KH) to train Sub-Saharan African pediatricians in Pediatric Emergency and Critical Care (PECC). This study describes the epidemiology and outcomes of children admitted to the pediatric intensive care unit (PICU) or high dependency unit (HDU) at KH, a PECC-Kenya training site in rural Kenya.

Methods: This retrospective study describes patient demographics, diagnoses and outcomes for all PICU and HDU admissions at AIC Kijabe Hospital from January 2019 to July 2024.

Results: We included 889 PICU/HDU admission encounters for 815 unique patients, with a median age of 1 (0.1-4) year, and 433 (48.7%) female sex. Just over half (464, 52.2%) were admitted from casualty, with the remaining 425 (47.8%) directly admitted from the operating room or referring hospitals. Allowing for multiple diagnoses per encounter, the most frequent discharge diagnoses were surgical (241, 27.1%), neurologic (195, 21.9%), malnutrition (189, 21.3%), sepsis (187, 21%), electrolyte abnormalities (167, 18.8%), respiratory illness (167, 18.8%), and cardiac disease (111, 12.5%). Overall mortality was 17.1%. Of the 139 hospital deaths, 41 (29.5%) occurred within 72 hours. The most common diagnoses among non-survivors included sepsis (55, 39.6%), electrolyte abnormalities (41, 29.5%), respiratory illness (38, 27.3%), and surgical problems (38, 27.3%). On admission, survivors had lower PELOD-2 scores than non-survivors (2 (IQR 0-4) vs 14 (IQR 9-17) respectively). A higher proportion of non-survivors received non-invasive mechanical ventilation (70/139 (50.4%) vs. 291/750 (38.8%)), invasive mechanical ventilation (103/139 (74.1%) vs. 115/750 (15.4%)), and vasoactive medications (82/139 (59.0%) vs. 82/750 (10.9%)).

Conclusion: Children hospitalized with critical illness at AIC Kijabe Hospital have high mortality and frequently require mechanical ventilation and vasoactive medications. Sepsis and respiratory illnesses are common causes of admission and death, highlighting the importance of building capacity for sepsis care and respiratory support. The high proportion of surgical complaints reflects Kijabe Hospital’s high surgical volume. Additional important comorbidities include malnutrition, neurologic conditions and electrolyte abnormalities. Tailoring training programs like PECC-Kenya to local epidemiology, including post-operative care, neurologic emergencies, malnutrition, and sepsis, will build pediatric emergency and critical care capacity, which is essential to further reduce child mortality in this region.