Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique

Abstract

Background An effective pediatric emergency care (PEC) system is key to reduce pediatric mortality in low-income countries. While data on pediatric emergencies from these countries can drive the development and adjustment of such a system, they are very scant, especially from Africa. We aimed to describe the characteristics and outcomes of presentations to a tertiary-care Pediatric Emergency Department (PED) in Mozambique. Methods We retrospectively reviewed PED presentations to the "Hospital Central da Beira" between April 2017 and March 2018. Multivariable logistic regression was used to identify predictors of hospitalization and death. Results We retrieved 24,844 presentations. The median age was 3 years (IQR 1-7 years), and 92% lived in the urban area. Complaints were injury-related in 33% of cases and medical in 67%. Data on presenting complaints (retrieved from hospital paper-based registries) were available for 14,204 (57.2%) records. Of these, respiratory diseases (29.3%), fever (26.7%), and gastrointestinal disorders (14.2%) were the most common. Overall, 4,997 (20.1%) encounters resulted in hospitalization. Mortality in the PED was 1.6% (62% ≤4 hours from arrival) and was the highest in neonates (16%; 89% ≤4 hours from arrival). A younger age, especially younger than 28 days, living in the extra-urban area and being referred to the PED by a health care provider were all significantly associated with both hospitalization and death in the PED at the multivariable analysis. Conclusions Injuries were a common presentation to a referral PED in Mozambique. Hospitalization rate and mortality in the PED were high, with neonates being the most vulnerable. Optimization of data registration will be key to obtain more accurate data to learn from and guide the development of PEC in Mozambique. Our data can help build an effective PEC system tailored to the local needs.

Paediatric emergency care at an academic referral hospital in Mozambique

“…Overall, 62% of patients had primary respiratory complaints, compared to only 29% reported from HCB [13] . This is likely due to HCM seeing many more patients presenting directly from home without referral, as 73% of all respiratory diagnoses were URIs, and across all age groups, this was the most common diagnosis.…”

“…This may reflect patient and family perceptions of higher quality care available at HCM. A recent analysis of emergency center visits from Hospital Central de Beira (HCB), the referral hospital for central Mozambique, found that a much larger proportion of patients (44%) were referred from primary health centers or lower level hospitals [13] .…”

A retrospective analysis of emergency department usage in rural and semi-urban indigenous Guatemalan populations

“…At a hospital in Malawi, ETAT was responsible for halving mortality rate for pediatric inpatients. [73][74][75] This system has already been used in select referral hospitals and primary health centers in Guatemala to successfully train health providers in acute pediatric care, and could be implemented at other rural health centers across the country, including the Hospital Parroquial de San Lucas Tolimán. 46,76 Respiratory infections remain a top global cause of morbidity and mortality.…”

Portrait of the Emergency Department at Orotta National Referral and Teaching Hospital in Asmara, Eritrea: A Prospective Observational Study

“…Although the importance of EMS is well documented; 5 services in sub-Saharan Africa (SSA) have been described as overstretched and overburdened. 6 Emphasizing this point, some investigators have noted that these systems are not only under-developed; 7 , 8 they also lack surge capacity and resilience. 5 Fundamental barriers include a high volume of critically ill patients – even in non-crisis situations; a general shortage of essential equipment and supplies; inadequate manpower (EM specialists) and under-developed research infrastructure and capacity – the limited research that exists has been described as small, ad hoc efforts, in individual facilities.…”