Paediatric emergency care at an academic referral hospital in Mozambique

Abstract

Background Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0–14 years of age seen in the 12-month period from August 2018–July 2019 were included. Descriptive statistical analyses were performed. Results Data from 346 days and 64,966 patient encounters were analyzed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URI), gastroenteritis, asthma, and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%), and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria, and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion This epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilisation. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis.

Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya

“…Given our setting in KNH's PEU, our study population was limited to patients no older than 12 years and only included medical emergencies (ie, no trauma or surgical emergency cases). However, previous research examining pediatric emergency medicine outcomes for both medical and injury patients presented similar population characteristics, including sex, age, and admission outcomes, as our study 24,25 . Thus, our results may have application to pediatric patients regardless of the reason for seeking care, but further evaluation of ETAT+ among a general pediatric population is needed.…”

“…However, previous research examining pediatric emergency medicine outcomes for both medical and injury patients presented similar population characteristics, including sex, age, and admission outcomes, as our study. 24,25 Thus, our results may have application to pediatric patients regardless of the reason for seeking care, but further evaluation of ETAT+ among a general pediatric population is needed. In addition, the patient sampling process was not completely random, which could have introduced selection bias.…”