Mortality and its predictors among children admitted in the general paediatric ward, Muhimbili National Hospital from October 2017 to April 2018

Abstract

Background Child mortality is one of the sensitive indicators of a country’s development. Global under 5- mortality is still high especially during the neonatal and infant period. Globally, annual underfive mortality has declined from 91 to 43 per 1000 live births from 1990 to 2015. In Tanzania, under-five and infant mortality rates declined from 147 to 67 and 99 to 43 deaths per 1,000 live births in the same period, respectively. There is variation in the causes of death among different age groups. More interventions are needed during these periods to reduce mortality.Objective of this study was to determine mortality rate and its predictors among children admitted in the general paediatric wards, Muhimbili National Hospital from October 2017 - April 2018. Methodology: A prospective cohort study was designed to investigate the predictors of deaths occurring among children aged from 1-59 months admitted in the paediatric department wards from October 2017 to April 2018. Nine hundred and twenty-five (response rate 94.9%) consecutively admitted children were recruited and followed up until discharge or death. The cumulative incidence rate of mortality was calculated. Causes of death were identified and risk factors associated with mortality were assessed. Multivariate analysis was conducted to determine and quantify the relationship between different predictors of deaths. P-value of <0.05 was considered statistically significant. Result: A total of 925 children aged 1-59 months with a median age (IQR) of (13 (6, 26) months, male: female ratio of 1.5:1 participated in the study. The overall mortality rate was 12.2% (95% CI: 10.2%-14.5%). The leading underlying causes of death were septicaemia (27%), malnutrition (12%), congenital heart disease (12%), pneumonia (11%) and HIV (9%).\More deaths were observed at night, during the first 24 hours of admission and weekends. Predictors of mortality were found to be low wealth quintiles (lowest quintile (AOR=4.0; 95%CI: 1.19-13.51), second quintile (AOR=5.2; 95%CI: 1.65-16.69) and middle quintile (AOR=3.6; 95%CI: 1.14-11.33)), unconsciousness on admission (AOR = 18; 95%CI: 6.70- 56.82), inability to feed (AOR = 5.7; 95%CI: 1.97-16.51), lethargy (AOR = 4.9; 95%CI: 2.32-10.40), severe wasting (AOR = 4.5; 95%CI: 2.49-8.10) and respiratory distress (AOR = 2.6; 95% 1.40-4.97).

Conclusion: Mortality rate is still high compared to the WHO target. More deaths were observed during the first 24 hours of admission. Infectious diseases and malnutrition were the leading causes of death. Low household wealth, unconsciousness, inability to feed, lethargy, severe wasting and respiratory distress were significant predictors of deaths.

Recommendation: Care of the children should be improved in the first 24 hours of admission, during the nighttime and weekends. Clinicians should closely monitor children with predictors of mortality as they have a higher risk of dying.