February 2018 | Volume 6 | Article 381
published: 27 February 2018
Frontiers in Pediatrics | www.frontiersin.org
University of British
Ericka L. Fink,
University of Pittsburgh,
Amelie von Saint Andre-von Arnim,
University of Washington,
This article was submitted to
Pediatric Critical Care,
a section of the journal
Frontiers in Pediatrics
BeaneA, AthapattuPL, DondorpAM
and HaniffaR (2018) Commentary:
Challenges and Priorities for Pediatric
Critical Care Clinician–Researchers in
Low- and Middle-Income Countries.
Front. Pediatr. 6:38.
Commentary: Challenges and
Priorities for Pediatric Critical Care
Clinician–Researchers in Low- and
Abigail Beane1, Priyantha Lakmini Athapattu2, Arjen M. Dondorp3,4 and Rashan Haniffa1*
1 Network for Improving Critical Care Systems and Training (NICST), Colombo, Sri Lanka, 2 Ministr y of Health, Nutrition and
Indigenous Medicine, Colombo, Sri Lanka, 3 Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine,
Mahidol University, Bangkok, Thailand, 4 Centre for Tropical Medicine, Medical Sciences Division, University of Oxford,
Oxford, United Kingdom
Keywords: low- and middle-income countries, low resource settings, researchers, pediatric critical care, support
of research, surveys and questionnaires, intensive care unit
A commentary on
Challenges and Priorities for Pediatric Critical Care Clinician–Researchers in Low- and Middle-
by Von Saint Andre-Von Arnim AO, Attebery J, Kortz TB, Kissoon N, Molyneux EM, Musa NL, etal.
Front Pediatr (2017) 5:277. doi: 10.3389/fped.2017.00277
Von Saint Andre-Von Arnim and colleagues noted that LMIC clinicians should be empowered to
inuence local and global research agendas for critically unwell children (1). We too can report
that clinicians trained in LMIC acknowledge the need for systematic gathering of outcome data in
improving services and endorse the role that non-LMIC collaborators can play in contributing to
training, surveillance, and research (2). Interestingly, these perceptions were more strongly held
when compared to High Income Country (HIC) counterparts with experience in LMIC settings.
ese ndings perhaps point to untapped opportunities to upskill LMIC clinicians to build equitable
research and training partnerships with their non-LMIC counterparts.
Network for Improving Critical Care Systems and Training (NICST) is an LMIC-based organiza-
tion working collaboratively, since 2012, with clinical teams to build capacity for research, train-
ing, and continuous audit to improve patient outcomes (3). A collaboration between clinicians,
researchers, and educational experts based in HICs and LMIC, the network, funded in part by a UK
grassroots charity of the same name, links over 110 state and private sector hospitals and has trained
over 4,500 nurses and doctors in acute and critical care skills.
e NICST platform, a clinician-led mobile electronic health information initiative, is an example
of a setting-adapted national registry for critically unwell adults, children, and neonates in Sri Lanka
and beyond. Output from the registry supports a critical care bed availability system that facilitates
access to and utilization of resources and provides information on post-hospital outcomes (4).
Mobile applications linked to the platform improve the availability of information essential for the
care of individual patients and enable practical training for nurses and doctors (5). Partnered with
institutions based in HIC (UK and the Netherlands), it is creating educational opportunities (MSc,
PhD pathways) (6, 7) and undertaking frontline quality improvement projects in Sub-Saharan Africa
and South Asia.
Creating sustainable partnerships that harness the power of the existing LMIC-based network
enables equitable exchange of expertise and fosters greater understanding of setting-specic research
priorities. We anticipate that these successful collaborations coupled with rising awareness of the
importance of high-quality surveillance systems in LMIC will somewhat help address the challenges
Beane et al. NICS: Novel LMIC-Based Network
Frontiers in Pediatrics | www.frontiersin.org February 2018 | Volume 6 | Article 38
currently experienced by LMIC-based researchers approaching
traditional funding streams. We believe our model provides a
template for promoting setting-relevant research, which can
enable successful south-to-south (and perhaps south-to-north!)
RH and AB wrote the rst dra of the manuscript. AD and PA
approved and improved the manuscript. All the authors approved
1. Von Saint Andre-Von Arnim AO, Attebery J, Kortz TB, Kissoon N, Molyneux EM,
Musa NL, etal. Challenges and priorities for pediatric critical care clinician-
researchers in low- and middle-income countries. Front Pediatr (2017) 5:277.
2. Hania R, De Silva AP, de Azevedo L, Baranage D, Rashan A, Baelani I, etal.
Improving ICU services in resource-limited settings: perceptions of ICU work-
ers from low-middle-, and high-income countries. J Crit Care (2017) 44:352–6.
3. Network for Improving Critical Care Systems and Training (NICST). Available
from: www.nicst.com (accessed February, 2018).
4. Rathnayake S. Smart Content for Smart People Best Practices of Sri Lankan
e-Content and Applications of 2014. (2014). p. 28–30. Available from:
http://www.eldis.org/vle/upload/1/Document/1503/Smart Content for Smart
5. De Silva AP, Harischandra PL, Beane A, Rathnayaka S, Pimburage R,
Wijesiriwardana W, et al. A data platform to improve rabies prevention, Sri
Lanka. Bull World Health Organ (2017) 95(9):646. doi:10.2471/BLT.16.188060
6. Hania R, Mukaka M, Munasinghe SB, De Silva AP, Jayasinghe KS, Beane A,
etal. Simplied prognostic model for critically ill patients in resource limited set-
tings in South Asia. Crit Care (2017) 21(1):250. doi:10.1186/s13054-017-1843-6
7. Beane A, Padeniya A, De Silva AP, Stephens T, De Alwis S, Mahipala PG, etal.
Closing the theory to practice gap for newly qualied doctors: evaluation of
a peer-delivered practical skills training course for newly qualied doctors
in preparation for clinical practice. Postgrad Med J (2017) 93(1104):592–6.
Conict of Interest Statement: e authors declare that the research was con-
ducted in the absence of any commercial or nancial relationships that could be
construed as a potential conict of interest.
Copyright © 2018 Beane, Athapattu, Dondorp and Hania. is is an open-access
article distributed under the terms of the Creative Commons Attribution License
(CC BY). e use, distribution or reproduction in other forums is permitted, provided
the original author(s) and the copyright owner are credited and that the original
publication in this journal is cited, in accordance with accepted academic practice. No
use, distribution or reproduction is permitted which does not comply with these terms.