Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya

Abstract

Introduction:The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population.Methods: Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups.Results: Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves.Conclusions: Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resourcelimited settings.

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

“…Among the 3315 patients registered at the PEU during the data collection period, 332 pediatric patients were enrolled upon parental consent 3 . Of those enrolled participants, 323 had complete data on ETAT+ designation and disposition for the current analysis.…”

“…As described previously, trained research personnel were present in the PEU for 8-hour shifts that, intermittently, covered all 24 hours during the enrollment period. Every fifth patient arriving for care during these shifts was screened for enrollment 3 . Patients with consenting caregivers were enrolled and followed prospectively until PEU disposition.…”

“…Every fifth patient arriving for care during these shifts was screened for enrollment. 3 Patients with consenting caregivers were enrolled and followed prospectively until PEU disposition. Study personnel collected data on enrolled participants using structured study instruments.…”

“…Children in low- and middle-income countries (LMICs) continue to experience higher mortality rates—although the global under-five mortality rate is 37 deaths per 1000 live births, the rate in sub-Saharan Africa is double that, at 74 deaths per 1000 live births 1 . Many of these pediatric deaths are from preventable causes or are manageable through immediate health care, such as HIV, malaria, respiratory infections, diarrheal illness, maternal complications, and physical trauma 2,3 . In addition, hospitals in resource-limited countries often provide preventive and curative care together (eg, combining immunization, antenatal and urgent care clinics), resulting in difficulties in triage 4 .…”