Paediatric deaths in a tertiary government hospital setting, Malawi.

Harris, Caroline and Mills, Rowena and Seager, Ezgi and Blackstock, Sarah and Hiwa, Tamanda and Pumphrey, James and Langton, Josephine and Kennedy, Neil (2018) Paediatric deaths in a tertiary government hospital setting, Malawi. Paediatrics and international child health. pp. 1-9. ISSN 2046-9055.

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Official URL: https://www.tandfonline.com/doi/full/10.1080/20469...

Abstract

BACKGROUND

Malawisuccessfully achieved Millennium Development Goal (MDG) four by decreasing the under-5 mortality rate by two-thirds in 2012. Despite this progress child mortality is still high and in 2013, the leading causes of death in under-5s were malaria, acute respiratory infections and HIV/AIDS.

AIMS

To determine the causes of inpatient child death including microbiological aetiologies in Malawi.

METHODS

A prospective, descriptive study was undertaken in Queen Elizabeth Central Hospital over 12 months in 2015/2016. Data was collected for every paediatric covering HIV and nutritional status, cause of death, and microbiology. Deaths of inborn neonates were excluded.

RESULTS

Of 13,827 admissions, there were 488 deaths, giving a mortality rate of 3.5%. One-third of deaths (168) occurred in the first 24 h of admission and 255 after 48 h Sixty-eight per cent of those who died (332) were under 5 years of age. The five leading causes of death were sepsis (102), lower respiratory tract infection (67), acute gastroenteritis with severe dehydration (51), malaria (37) and meningitis (34). The leading non-communicable cause of death was solid tumour (12). Of the 362 children with a known HIV status 134 (37.0%) were HIV-infected or HIV-exposed. Of the 429 children with a known nutrional status, 93 had evidence of severe acute malnutrition (SAM). Blood cultures were obtained from 252 children 51 (20.2%) grew pathogenic bacteria with Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus being the most common.

CONCLUSION

Despite a significant reduction in paediatric inpatient mortality in Malawi, infectious diseases remain the predominant cause.

ABBREVIATIONS

ART: anti-retroviral therapy; Child PIP: Child Healthcare Problem Identification Programme; CCF: congestive cardiac failure; CNS: central nervous system; CoNS: coagulase-negative staphylococci; CSF: cerebrospinal fluid; DNA pcr: deoxyribonucleic acid polymerase chain reaction; ETAT: emergency triage assessment and treatment; LMIC: low- and middle-income countries; MDG: Millennium Development Goals; MRI: magnetic resonance imaging; MRSA: methicillin-resistant Staphylococcus aureus; NAI: non-accidental injury; NTS: non-typhi salmonella; PJP: Pneumocystis jiroveci pneumonia; PSHD: presumed severe HIV disease; QECH: Queen Elizabeth Central Hospital; RHD: rheumatic heart disease; RTA: road traffic accident; TB: tuberculosis; TBM: tuberculous meningitis; WHO: World Health Organization; SAM: severe acute malnutrition.

Item Type: Article
Subjects: WS Paediatrics. Child health
Divisions: Womens and Childrens > Paediatrics
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 23 Nov 2018 13:40
Last Modified: 23 Nov 2018 13:40
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1785

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