Pattern and Outcome of Patients Admitted at the Paediatric Intensive Care Unit at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Abstract

Background: A paediatric intensive care unit (PICU) is a specialized unit that provides medical care to critically ill children. Critical care in developing countries remains to be a cause of concern, owing to lack of expert support, diagnostic facilities, appropriate medications and equipments. A PICU was established in March 2019 at the Muhimbili National Hospital (MNH), a national referral centre, aiming at maximizing care for the critically ill children. Being a newly established field, there is a paucity of information regarding the admission patterns and outcome of these patients at PICU. Objective: The aim of this study was to determine the admission pattern, outcome, cause of death and factors associated with mortality among patients admitted at the PICU at MNH. Methodology: A retrospective descriptive cross-sectional study was performed, and patients aged 1 month – 14 years admitted at the PICU between March 2019 and February 2020 were included in the study. Medical files of 484 randomly selected patients were retrieved from the medical records. Following the exclusion criteria, data of 480 patients was analyzed for the cause of admission, outcome, cause of death and associated factors of mortality. These factors included age, sex, admission source, admission diagnosis, length of stay, need of mechanical ventilation (MV), paediatric Glasgow Coma Scale (PGCS) and presence of chronic underlying conditions. The statistical significance was set at p < 0.05 and multivariate analysis was used to identify the association between mortality and the associated factors. Results: Of the 653 admitted patients, data of 480 were analyzed. The median age at admission was 18 months (Interquartile range 1–174), with a male-to-female ratio of 1.4:1. The most frequent causes of PICU admissions were severe sepsis (22.9%), lower respiratory tract infections (LRTI) (22.5%), post-operative condition (12.3%), acute watery diarrhea (AWD)/dysentery (6.3%) and meningitis/encephalitis (5.6%). Infectious conditions accounting for 67.7% were the most common cause of admission in the PICU. The PICU mortality was 46.9%, and the most common cause of death (59.1%) was severe sepsis with or without multiorgan failure. Multivariate analysis showed that patients aged <1 year, patients admitted from general wards, patients requiring mechanical ventilation during stay at PICU, and patients with a length of stay of less than a week had significantly higher mortality. Conclusion: The common causes of PICU admissions at MNH were severe sepsis, LRTI, post-operative condition, AWD/dysentery and meningitis/encephalitis. The mortality rate in this study was 46.9%, and the most common cause of death was severe sepsis with or without multi-organ failure. The factors that were significantly associated with mortality in PICU included the age of the patient, admission source, need of mechanical ventilator and length of stay. Recommendations: Deliberate efforts should be put to strengthen the management of sepsis in paediatric population as it was the common cause of admission and death at PICU. Efforts should be put for early identification and management of critically ill patients admitted in hospitals so as to reduce mortality in this vulnerable group.