Observations from Mortality Trends at The Children’s Hospital, Accra, 2003-2013

Abstract

ObjectiveFacility-based studies provide an unparalleled opportunity to assess interventions deployed in hospitals to reduce child mortality which is not easily captured in the national data. We examined mortality trends at the Princess Marie Louise Children’s Hospital (PML) and related it to interventions deployed in the hospital and community to reduce child mortality and achieve the Millennium Development Goal 4 (MDG 4).MethodsThe study was a cross-sectional review of data on consecutive patients who died at the hospital over a period of 11 years, between 2003 and 2013. The total admissions for each year, the major hospital-based and population-based interventions, which took place within the period, were also obtained.ResultsOut of a total of 37,012 admissions, 1,314 (3.6%) deaths occurred and admissions tripled during the period. The average annual change in mortality was -7.12% overall, -7.38% in under-fives, and -1.47% in children ≥5 years. The majority of the deaths, 1,187 (90.3%), occurred in under-fives. The observed decrease in under-five (and overall) mortality rate occurred in a specific and peculiar pattern. Most of the decrease occurred during the period between 2003 and 2006. After that there was a noticeable increase from 2006 to 2008. Then, the rate slowly decreased until the end of the study period in 2013. There was a concomitant decline in malaria mortality following a pattern similar to the decline observed in other parts of the continent during this period. Several interventions might have contributed to the reduction in mortality including the change in malaria treatment policy, improved treatment of malnutrition and increasing paediatric input.ConclusionUnder-fives mortality at PML has declined considerably; however, the reduction in mortality in older children has been minimal and thus requires special attention. Data collection for mortality reviews should be planned and commissioned regularly in hospitals to assess the effects of interventions and understand the context in which they occur. This will provide benchmarks and an impetus for improving care, identify shortfalls and ensure that the gains in child survival are maintained.

Comorbidities and Factors Associated with Mortality among Children under Five Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of Jinja Regional Referral Hospital, Eastern Uganda

“…The finding in the current study was in line with the mortality trends by Tette et al [14] in Ghana that reported high mortality in males (52.2%) compared to females (47.8%) and similar to other studies in Africa, but it differed from the study in Mali which reported significantly higher case fatality rates among girls. More so, in Zambia, it was found that the mortality pattern was higher in males than females, and the mortality at 24 hours, 48 hours, and 1 week of admission was 93.2%, 88.7, and 29%, respectively [12].…”

Exploring factors influencing patient mortality and loss to follow-up in two paediatric hospital wards in Zamfara, North-West Nigeria, 2016–2018

“…We have shown that mortality rates in AGH ITFC and IPD were in the range of those observed in similar settings, but also consistently high over the study period [3][4][5][6][7]25]. The observed LTFU rates were below those reported in other countries [6,16].…”

“…The burden of under-five mortality disproportionately affects low-and middle-income countries, with half of the world's total under-five deaths occurring in sub-Saharan Africa alone [2]. Paediatric inpatient mortality ranges from 3% to 21% across different Sub-Saharan countries and different hospital settings including specialised paediatric care [3][4][5][6][7]. Although Nigeria has seen a consistent reduction in mortality for children under five years of age from 213 per 1000 live births in 1990 to 104 per 1000 live births in 2015, childhood mortality remains high, with the national average reported to be around 120 per 1000 live births in 2017 [8][9][10].…”

Under-five mortality and associated factors in southeastern Ethiopia

“…On the other hand, different studies conducted on under-five mortality demonstrated lower mortality rates compared with our study. Observations from the studies conducted in Ghana and Namibia showed under-five mortality of 3.62% and 1.2%, respectively [ 13 , 14 ]. Besides, cohort study on predictors of post neonatal mortality in Western Kenya indicated 4.6% post-neonatal mortality [ 15 ].…”