Survival and Predictors of Mortality Among Critically Ill Children Admitted to an Intensive Care Unit in a Resource-Limited Setting in Southeastern Ethiopia: A Prospective Cohort Study.

Background: Mortality among critically ill children remains disproportionately high in low- and middle-income countries (LMICs), reflecting persistent challenges related to limited critical care capacity, delayed healthcare utilization, and a substantial burden of preventable and treatable illnesses. Despite ongoing efforts to improve pediatric critical care services in Ethiopia, prospective data on survival outcomes and predictors of mortality among critically ill children remain scarce. This study aimed to assess survival outcomes and identify independent predictors of mortality among children admitted to the intensive care unit at ARTH in southeastern Ethiopia. Methods: An institution-based prospective cohort study was conducted among 305 critically ill children admitted to the intensive care unit (ICU) at ARTH between June 2023 and November 2024. Participants were followed from ICU admission until death or censoring. Survival probabilities were estimated using the Kaplan-Meier method, and differences between groups were compared using the log-rank test. Cox proportional hazards regression analysis was performed to identify independent predictors of mortality. Adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) were reported, and statistical significance was set at Results: Among the 305 enrolled patients, 129 (42.3%) died during follow-up. The overall mortality incidence rate was 7.1 deaths per 100 person-days (95% CI: 5.86-8.32), and the median survival time was 10 days (95% CI: 7.58-12.42). Most deaths (86.8%) occurred within the first 7 days of ICU admission. Independent predictors of mortality included lack of health insurance (AHR = 2.03; 95% CI: 1.22-3.39), MODS (AHR = 1.73; 95% CI: 1.09-2.73), AKI (AHR = 1.82; 95% CI: 1.13-2.93), anemia at admission (AHR = 1.73; 95% CI: 1.15-2.60), and a modified PIM-2 score greater than five (AHR = 1.58; 95% CI: 1.03-2.43). Conclusion: In-ICU mortality among critically ill pediatric patients was alarmingly high, with the greatest risk occurring during the first week of admission. Both clinical severity indicators and socioeconomic factors were independently associated with mortality. These findings highlight the need for early risk stratification, timely targeted interventions, and policies that improve financial access to critical care services to reduce pediatric ICU mortality in resource-constrained settings.