Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia

Abstract

BackgroundGlobal childhood mortality rates remain high. Millennium Development Goal 4 focused efforts on reducing rates by two-thirds between 1990 and 2015. In Ethiopia, child mortality rates dropped 71 % from 1990 to 2015, however it is estimated that 184,000 Ethiopian children die each year. There is limited information about pediatric hospital admissions in Ethiopia. Our aims were to examine the temporal relationship of mortality to admission, describe the demographics, and identify cause mortality of children admitted to the Zewditu Memorial Hospital (ZMH).MethodsA four-year retrospective review of pediatric admissions was conducted at the pediatric emergency room and pediatric hospital ward at ZMH in Addis Ababa, Ethiopia. Admission entries from 2011–2014 of children age 29 days-14 years were reviewed. Age, gender, admission date, disease classification, discharge status and date were obtained. Patient gender was compared using Chi-square analysis. A descriptive analysis was used for age and cause mortality.ResultsA total of 6866 patient entries were reviewed. The proportion of admissions younger than age 5 was 0.747 (95 % CI 0.736-0.757). Overall mortality was 0.042 (95 % CI, 0.037-0.047). The proportion of recorded deaths occurring within 2 days of admission was 0.437 (95 % CI 0.380-0.494). The proportion of male admissions was significantly higher than female admissions in all age groups (male 0.575, p < 0.0001, 95 % CI 0.562-0.586). The main causes of mortality were pneumonia (0.253, 95 % CI, 0.203-0.303), severe acute malnutrition (0.222, 95 % CI 0.174-0.27), HIV/AIDS-related complications (0.056, 95 % CI 0.029-0.083), spina bifida (0.049, 95 % CI 0.024-0.074), and hydrocephalus (0.045, 95 % CI 0.021-0.069).ConclusionsOur study revealed a lower mortality rate than previously reported in Ethiopia. Despite this, 44 % of pediatric hospital mortality occurred early during hospitalization, higher than reported at other Ethiopian hospitals. This adds further evidence that systematic efforts should be dedicated to improve pediatric emergency care. Admissions included 58 % male patients, similar to other reports in Ethiopia implying that this may be a nation-wide phenomenon. The observed disparity may be due to societal factors regarding care-seeking behaviors or male predilection for respiratory illness warranting further investigation. Cause mortality patterns were similar to reports in analogous settings.

Prevalence and associated factors of pediatric emergency mortality at Tikur Anbessa specialized tertiary hospital: a 5 year retrospective case review study

“…Malnutrition and diarrhea were common co-morbid conditions associated with the primary causes of death. This is consistent with studies conducted in Kenya, Ghana [ 22 , 44 ] and Ethiopia [ 18 , 26 ]. Additionally, in our study diarrheal disease was significantly associated with pediatric mortality.…”

“…Our study found that congestive heart failure and hematological malignancy were top primary causes of school age group mortality. This is consistent with findings in China and Nigeria [ 19 – 21 ], but quite different to other studies in Nigeria, Ethiopia and sub-Saharan Africa countries which suggested a smaller role for these conditions [ 26 , 39 , 40 ]. This disparity may be due to lack of cardiac and pediatric oncology services in developing countries.…”

“…Children presenting to our emergency department, had a mortality rate of 4.1%. The incidence of pediatric mortality in this study was lower than the previous studies conducted in Ethiopia [ 23 – 26 ]. This decrease may be due to improvements in the maternal and child urban health care settings.…”

“…This decrease may be due to improvements in the maternal and child urban health care settings. Despite this low mortality rate, early death less than 24 h after admission 107 (31.7%) was still high albeit, lower than other studies [ 18 , 19 , 26 , 27 ].…”

Predictors of undesirable treatment outcome of severe acute malnutrition inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study

“…The SDG goal 2.2 concentrates on ending all forms of malnutrition as it is the dominant cause of death among under five children (3). Ethiopia is one of the countries with high under five child mortality rate, even though the under-five mortality rate has been significantly reduced from earlier years it is still unacceptably high(55.2 deaths per 1,000 live births in 2018) (7). According to the Ethiopian Mini Demographic and Health Survey report 2019, 37% of under five children are stunted, 12% severely stunted, 7% wasted, 1% severely wasted 21% underweight and 6% severely underweight (8).…”