From Caseload to Health System Change: Patterns and Outcomes of Pediatric ENT Emergencies in Burundi

Background: Pediatric ENT emergencies are high-acuity presentations that require rapid intervention. In low-resource settings, they expose system fragilities, limited pediatric airway capacity, inequitable access, and high empirical antibiotic use, yet data from Burundi remain scarce. Objective: To analyze epidemiological patterns, etiologies, access inequities, management pathways, and antibiotic exposure among pediatric ENT emergencies at CHUK and derive feasible system-oriented reforms. Methods: Retrospective review of 651 pediatric ENT emergency cases (0 - 15 years) at CHUK from January 2018 to December 2019. Variables included sociodemographic features, geographic origin, symptoms, diagnoses, severity category, management, and outcomes. Fisher’s exact test assessed associations between age and etiology. Antibiotic use was evaluated relative to WHO AWaRe steward-ship principles. Results: Pediatric ENT emergencies accounted for 10.73% of all ENT consultations. Children < 5 years constituted 70.81% (mean age 4.08 years). Urban residence dominated (61.14% from Bujumbura Mairie). Peak presentations occurred in March and June. Etiologies were infectious (45.01%), foreign bodies (42.55%), traumatic/hemorrhagic (10.14%), malformative (0.92%), functional (0.92%), and tumoral (0.46%). Absolute emergencies (9.52%) were chiefly tracheo-bronchial foreign bodies (51.61%) and acute laryngitis (20.97%). Antibiotics were prescribed in 91.37% of all cases, including many non-infectious presentations. Outcomes were favorable in 19.35%; complications occurred in 2.31%; no deaths occurred; outcomes were undocumented in 78.19%. Conclusion: Pediatric ENT emergencies at CHUK are frequent, preventable, age-concentrated, and inequity-skewed. The high rate of non-indicated antibiotic use reflects systemic uncertainty rather than clinical need. Standardized triage training, district-level airway management capabilities, caregiver foreign-body prevention programs, and WHO AWaRe-aligned antibiotic stewardship can significantly reduce morbidity while preserving antimicrobial effectiveness.