641: Resources and inequities among pediatric critical care facilities in Pakistan

Introduction: With persistent population growth and the need to rapidly provide healthcare coverage in Pakistan, the need to enhance the critical care capacity may also have increased. This study aims to evaluate the current landscape of pediatric critical care facilities in Pakistan.Methods: We conducted a nationwide cross-sectional survey. Our survey tool was modified from a previously used innovative tool, based on the Partners In Health 4S (Space, Staff, Stuff, Systems) framework. The tool was administered via email and or telephonic correspondence. All facilities accredited for pediatric training were selected for this survey. We stratified and analyzed the data between the public and private healthcare sectors of Pakistan using Fisher’s exact test and Chi-square analysis. We employed a scoring system in which each of the items of our capacity assessment checklist were given a score of 1, if definitively available. We added the score for each component and used a weighted index to score each denominator out of 25.Results: A total of 114 hospitals were identified and approached in this study, of which 76(66.7%) responded. 53(69.7%) of these hospitals had a Pediatric Intensive Care Unit (PICU) with 667 beds and 50 mechanical ventilators. 32(60.3%) PICUs were in Punjab and only 1(1.9%) in Baluchistan indicating vast geographical disparities. 44 (83.0%) PICUs were present in metropolitan areas as compared to 8(17.0%) PICUs in rural/peri-urban areas. There were 38(71.7%) public hospitals whereas there were 15(28.3%) private hospitals overall. Trained intensivists were present in 16(30.2%) PICUs while 25(47.2%) PICUs had an optimal nurse ratio (≥1:3). Private hospitals were better resourced in many domains of our 4 components. The Stuff component scored more than the other three components using ANOVA testing (p-value=0.003). On cluster analysis, public hospitals ranked higher than private ones in Space and Stuff, along with the overall clusters.Conclusions: Our study shows that PICU is progressing is Pakistan but highlighted the deficiencies in the pediatric critical care infrastructure in Pakistan. There is a general lack of resources that is disproportionately seen in the public sector. A lack of qualified intensivists and nursing staff poses a challenge to PICUs