Table 2.
Importance of challenges and solutions to pediatric critical care (PCC) research in LMIC.
| Research description, challenges and solutions | Total | SE Asia | Africa | Latin America | Eastern Europe |
|---|---|---|---|---|---|
| n = 47 (%) | n = 5 (%) | n = 12 (%) | n = 29 (%) | n = 1 (%) | |
| Importance of PCC research in LMIC | |||||
| Critical | 18 (38) | 3 (60) | 5 (42) | 9 (31) | 1 (100) |
| Very important | 20 (43) | 1 (20) | 4 (33) | 15 (52) | 0 (0) |
| Important | 9 (19) | 1 (20) | 3 (25) | 5 (17) | 0 (0) |
| Most important reason to do research | |||||
| Affect positive change in clinical care | 24 (51) | 3 (60) | 6 (50) | 14 (48) | 1 (100) |
| Establish guidelines/protocols | 13 (28) | 2 (40) | 3 (25) | 8 (28) | 0 (0) |
| Greater understanding of disease | 2 (4) | 0 (0) | 0 (0) | 1 (3) | 0 (0) |
| Increase resource availability | 3 (6) | 0 (0) | 2 (17) | 1 (3) | 0 (0) |
| Quality and safety | 4 (9) | 0 (0) | 1 (8) | 3 (10) | 0 (0) |
| Key areas of research in LMIC | |||||
| Sepsis | 18 (38) | 2 (40) | 3 (25) | 12 (41) | 1 (100) |
| Trauma | 12 (26) | 0 (0) | 1 (8) | 10 (34) | 1 (100) |
| Invasive and non-invasive positive pressure ventilation | 14 (30) | 0 (0) | 3 (25) | 11 (38) | 0 (0) |
| Quality improvement and patient safety | 11 (23) | 2 (40) | 2 (17) | 7 (24) | 0 (0) |
| Health-care associated infections | 9 (19) | 3 (60) | 2 (17) | 4 (14) | 0 (0) |
| ARDS/ALI | 7 (15) | 1 (20) | 0 (0) | 6 (21) | 0 (0) |
| Cost-effectiveness | 7 (15) | 1 (20) | 5 (42) | 1 (3) | 0 (0) |
| Education/capacity building | 6 (13) | 1 (20) | 2 (17) | 3 (10) | 0 (0) |
| Nutrition | 6 (13) | 2 (40) | 0 (0) | 4 (14) | 0 (0) |
| Mortality risk/severity of illness scores | 5 (11) | 1 (20) | 0 (0) | 4 (14) | 0 (0) |
| Ethics and palliative care | 5 (11) | 0 (0) | 1 (8) | 4 (14) | 0 (0) |
| Personal benefits of research | |||||
| Research collaboration | 33 (70) | 3 (60) | 6 (50) | 23 (79) | 1 (100) |
| Peer recognition | 29 (62) | 3 (60) | 7 (58) | 18 (62) | 1 (100) |
| Career advancement | 19 (40) | 3 (60) | 6 (50) | 9 (31) | 1 (100) |
| Salary | 6 (13) | 0 (0) | 4 (44) | 2 (7) | 0 (0) |
| Other | 4 (9) | 2 (40) | 1 (8) | 1 (3) | 0 (0) |
| Research challenges | |||||
| Lack of funding | 28 (60) | 4 (80) | 8 (67) | 16 (55) | 0 (0) |
| High clinical burden | 22 (47) | 3 (60) | 3 (25) | 15 (52) | 1 (100) |
| Limited research support staff | 22 (47) | 3 (60) | 3 (25) | 16 (55) | 0 (0) |
| IRB issues | 12 (26) | 0 (0) | 4 (33) | 7 (24) | 1 (100) |
| Lack of statistical support | 12 (26) | 2 (40) | 0 (0) | 9 (31) | 1 (100) |
| Limited research training opportunities | 10 (21) | 1 (20) | 3 (25) | 6 (21) | 0 (0) |
| Finding research mentor(s) | 7 (15) | 0 (0) | 5 (42) | 2 (7) | 0 (0) |
| Difficulty with publications | 8 (17) | 1 (20) | 2 (17) | 5 (17) | 0 (0) |
| Lack of reliable medical records | 4 (9) | 0 (0) | 3 (25) | 1 (3) | 0 (0) |
| Study subject recruitment | 4 (9) | 0 (0) | 1 (8) | 3 (10) | 0 (0) |
| Research solutions | |||||
| More funding for low resource settings | 33 (70) | 5 (100) | 8 (67) | 19 (66) | 1 (100) |
| Access to mentors in HIC | 24 (51) | 3 (60) | 8 (67) | 13 (45) | 0 (0) |
| Access to research training | 21 (45) | 0 (0) | 4 (33) | 16 (55) | 1 (100) |
| Access to research network | 18 (38) | 2 (40) | 3 (25) | 13 (45) | 0 (0) |
| Improved medical records | 16 (34) | 2 (40) | 3 (25) | 10 (34) | 1 (100) |
| Opportunities to present | 9 (19) | 1 (20) | 3 (25) | 5 (17) | 0 (0) |
| Streamlined IRB review | 6 (13) | 0 (0) | 3 (25) | 3 (10) | 0 (0) |
| Protected research time | 4 (9) | 2 (40) | 0 (0) | 2 (7) | 0 (0) |
| HIC research collaborations | 27 (57) | 4 (80) | 8 (67) | 14 (48) | 1 (100) |
| Importance of collaboration | |||||
| Critical | 4 (9) | 0 (0) | 3 (25) | 0 (0) | 1 (100) |
| Very | 12 (26) | 3 (60) | 3 (25) | 6 (21) | 0 (0) |
| Important | 6 (13) | 0 (0) | 1 (8) | 5 (17) | 0 (0) |
| Less | 3 (6) | 1 (20) | 0 (0) | 2 (7) | 0 (0) |
| Not | 1 (2) | 0 (0) | 0 (0) | 1 (3) | 0 (0) |
| Benefits of collaboration | |||||
| Research training | 21 (45) | 0 (0) | 6 (50) | 14 (48) | 1 (100) |
| Experience in manuscript preparation | 19 (40) | 2 (40) | 4 (33) | 12 (41) | 1 (100) |
| Established guidelines | 16 (34) | 3 (60) | 3 (25) | 9 (31) | 1 (100) |
| Financial support | 13 (28) | 0 (0) | 5 (42) | 8 (28) | 0 (0) |
| Medical supplies | 9 (19) | 0 (0) | 6 (50) | 3 (10) | 0 (0) |
| Other | 5 (11) | 1 (20) | 2 (17) | 2 (7) | 0 (0) |
| Problems with collaboration | |||||
| Lack of understanding of local setting | 18 (38) | 1 (20) | 6 (50) | 11 (38) | 0 (0) |
| Lack of sustainable benefit | 12 (26) | 0 (0) | 6 (50) | 6 (21) | 0 (0) |
| Communication limitations | 12 (26) | 0 (0) | 3 (25) | 1 (3) | 0 (0) |
| Lack of data sharing | 9 (19) | 1 (20) | 1 (8) | 6 (21) | 1 (100) |
| Lack of local research administration | 7 (15) | 2 (40) | 3 (25) | 2 (7) | 0 (0) |
| Lack of proper acknowledgment | 7 (15) | 1 (20) | 1 (8) | 4 (14) | 1 (100) |
| Dissimilar vision and goals | 7 (15) | 0 (0) | 1 (8) | 6 (21) | 0 (0) |
| Ethical conflict | 4 (9) | 1 (20) | 0 (0) | 3 (10) | 0 (0) |
| Political barriers | 4 (9) | 0 (0) | 3 (25) | 1 (3) | 0 (0) |
| Lack of high tech equipment | 1 (2) | 0 (0) | 1 (8) | 0 (0) | 0 (0) |
| Benefits of collaboration outweigh problems | 29 (62) | 4 (80) | 8 (67) | 16 (55) | 1 (100) |
LMIC, low- and middle-income counties; HIC, high-income countries; SE, South East; ARDS/ALI, acute respiratory distress syndrome/acute lung injury; IRB, Institutional Review Board.