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ORIGINAL ARTICLE
Year : 2015  |  Volume : 18  |  Issue : 1  |  Page : 1-3

Morbidity and mortality of childhood illnesses at the emergency pediatric unit of a tertiary hospital, north-eastern Nigeria


1 Department of Pediatrics, University of Maiduguri College of Medical Sciences, Azare, Nigeria
2 Department of Pediatrics, Federal Medical Centre, Azare, Nigeria

Date of Web Publication26-Feb-2015

Correspondence Address:
Yauba Mohammad Sa'ad
Department of Paediatrics, University of Maiduguri College of Medical Sciences, PMB - 1069, Maiduguri, Borno
Nigeria
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DOI: 10.4103/1118-8561.152150

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  Abstract 

Background: Under-five morbidity and mortality from childhood preventable diseases are still very high in most of the developing countries, especially Nigeria. We describe the morbidity and mortality of childhood illnesses at the Emergency Pediatric Unit (EPU) of the Federal Medical Centre, Azare. Materials and Methods: A retrospective study of Emergency Pediatric Unit admissions over a 1-year period. Epi-info statistical software was used for data analysis. Results: A total of 1,161 patients, aged 1 month to 13 years with a mean age (±1 SD) of 9.8 ± 2.6 years were admitted into EPU during the period. There were 576 (49.6%) males and 585 (50.4%) females and 1,034 (89.1%) patients were children under 5 years of age. The major causes of admission were malaria (44.8%). There were 103 (8.9%) discharges, 886 (76.3%) transfers to pediatric wards, 38 (3.3%) referrals to other hospitals, and 11 (0.9%) discharges against medical advice. There were 123 (10.6%) deaths during the period of the study with 107 (87.0%) of the deceased being children ≤5 years of age. Severe malaria 61 (49.6%) was the major cause of deaths in the unit, followed by Protein energy malnutrition (PEM) and pneumonia occurring in each of 10 (8.1%) patients. Conclusion: Malaria, PEM, and pneumonia remained the major causes of morbidity and mortality, especially among the under-five children.

Keywords: Admissions, emergency pediatric unit, morbidity, mortality, pattern


How to cite this article:
Sa'ad YM, Hayatu A, Al-Mustapha II, Orahachi YM, Hauwa MU. Morbidity and mortality of childhood illnesses at the emergency pediatric unit of a tertiary hospital, north-eastern Nigeria. Sahel Med J 2015;18:1-3

How to cite this URL:
Sa'ad YM, Hayatu A, Al-Mustapha II, Orahachi YM, Hauwa MU. Morbidity and mortality of childhood illnesses at the emergency pediatric unit of a tertiary hospital, north-eastern Nigeria. Sahel Med J [serial online] 2015 [cited 2019 Jun 27];18:1-3. Available from: http://www.smjonline.org/text.asp?2015/18/1/1/152150


  Introduction Top


The mortality of children under the age of 5 years in Nigeria is still high. [1] An appraisal of the morbidity and mortality pattern in our emergency pediatric unit (EPU) would avail us the opportunity to assess our strides in working toward achieving the Millennium Development Goal 4 target that sets to reduce under-five mortality rate. [2] It would also help us identify the common childhood illnesses causing morbidity and mortality. The control of these diseases would eventually improve the children's quality of life in our locality. We present a retrospective data of all admissions to determine the trend of morbidity and mortality in our emergency pediatric unit (EPU) over a period of 1 year.


  Materials and methods Top


Federal Medical Centre Azare is located in Azare, the second largest town in Bauch state, northeast Nigeria. Azare is located about 250 km from Bauchi, the capital city of Bauchi state and the town has an estimated population of 110,452 [1] who are mostly peasant farmers. The centre is the second largest hospital in the state. The pediatric department of the hospital includes EPU, pediatric medical ward (PMW), special care baby unit (SCBU), and pediatric outpatient department (POPD). For the purpose of this study, only case records of the patients admitted into the EPU were used. The cases were retrospectively recruited using the ward register and the hospital's medical records between January 2012 and December 2012. The extracted data included age, sex, date of admission, cause of admission, and outcome and probable cause of death. The outcomes are categorized as discharges, transfer to other wards, referrals, and death. The data collected were entered into the Epiinfo statistical software package version 7.1.2.0. A P value less than 0.05 were considered statistically significant. An ethical approval from the Hospital Ethics Committee was obtained.


  Results Top


A total of 1,161 patients were admitted into the hospital's EPU during the 1-year period. Their ages ranged from 1 month to 12 years with mean of 6.2 ± 2.0 years. The highest admission rate was in the months of September and October representing 204 (17.6%) and 159 (13.7%) patients, respectively. There were 576 males and 585 females. Of the 1,161 children admitted in to the unit, 1034 (89.1%) were less than 5 years of age out of which 505 (48.8%) were males and 529 (51.2%) were females;χ2 = 1.99, P = 0.16. Of the remaining 127 (10.9%) children who were above 5 years of age, 71 (55.9%) were males while 56 (44.1%) were females; χ2 = 1.99, P = 0.16 [Table 1].
Table 1: Age and sex distribution among 1,161 admissions


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Morbidity

Majority of the patients, 520 (44.8%), had malaria while 104 (9.0%) had PEM. Other indications for admissions included sickle cell anemia 82 (7.1%), acute diarrheal disease 67 (5.8%), sepsis 66 (5.7%), pneumonia 62 (5.3%), typhoid fever 40 (3.4%) [Table 2]. Among the 520 children with severe malaria, 299 (57.5%) were males while 221 (42.5%) were females; χ2 = 5.55, P = 0.02. However, among the 93 subjects with PEM females were 50 (53.8%) while males were 43 (46.2%). Tetanus was the least condition occurring in 2 (0.4%) males and 3 (0.6%) females [Table 2]. Most admissions were in the months of August to November with peak period in September [Figure 1].
Figure 1: Monthly variation in number of admissions and mortalities

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Table 2: Major causes of admission into the emergency pediatric unit


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Mortality

Of the 1,161 children admitted, 123 died giving the overall mortality rate of 10.6%. Of the 123 deaths, 69 (56.1%) were males while 54 (43.9%) were females; χ2 = 6.75, P = 0.01. One hundred and seven (87.0%) deaths were among children aged ≤5 years out of which 82 (66.7%) were among children aged ≤1 year. Severe malaria recorded the highest mortality among the 123 deaths occurring in 61 (49.6%) patients. This was followed by PEM and pneumonia occurring in 10 (8.1%) patients each. The least cause of death among the study population was sickle cell anemia occurring in only 2 (1.6%) cases. Other causes of deaths were as shown in [Table 3]. Of the 1161 admissions, 886 (76.3%) were transferred to the wards, 103 (8.9%) were discharged and 123 (10.6%) died. Thirty eight (3.3%) patients were referred to other health care centers while 11 (0.9%) were discharged against medical advice.
Table 3: Causes of deaths distribution among the study population


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  Discussion Top


This study showed that morbidities among the under-five age group and this finding is similar to that reported by others. [2],[3] The equal distributions of childhood admissions among the boys and girls observed in the present series contrasted with the findings by Abhulimhen-Iyoha and Okolo [2] in Benin and Ibeziako and Ibekwe [4] in Enugu, respectivelywhere male admissions were predominant. Though the reason for the difference has not been established, it may be due to regional variation in the health seeking behavior on behalf of children for sociocultural reasons. [5]

Most admissions were in the months of August to November with peak period in September a finding similar to reports in India [6] and Nigeria. [7] The high incidence of malaria high during the rainy season may explain why most admissions occurred during this period. This finding contrasted with that observed by Duru et al., [8] in a local study in Bayelsa, Nigeria, where the peak admissions in their study were in the months of January, May, and December, the period which coincides with less rains in that region.

This study showed mortality of 10.6% which is similar to what was documented in Lagos, [9] and lower than the 15.1% reported from Zaira, [10] all in Nigeria but, higher than the 7.8% reported in South Africa. [11] Infectious disease was the major cause of childhood admissions in the current report. This is similar to what was documented by Duru et al.[8] in Bayelsa state, South-south Nigeria. Severe malaria, in keeping with the findings by some studies from Nigeria [8],[12] and Muzambique, [5] was the most common cause of death in this study.

Although the discharge rate (8.9%) was low in this study, the outcome of admissions showed a good transfer rate (76.3%) out of the EPU a finding similar to that reported in Benin City [2] and Enugu [4] all in Nigeria. The 0.9% rate of discharge against medical advice reported in this study was markedly lower than the 7.4%, 6.3%, and 5.4% reported in the Nigerian studies reported by Okechukwu [13] in Abuja, Onyiriuka [14] in Benin and Duru et al.[8] in Bayelsa, respectively.


  Conclusion Top


Malaria, PEM, and pneumonia are still the leading cause of morbidity and mortality in children especially the under-fives. There remains the need to intensify efforts toward the development of malaria vaccines as a preventive strategy in this part of the world.

 
  References Top

1.
Available from: http://www.world-gazetteer.com. [Last accessed on 2013 Dec 12].  Back to cited text no. 1
    
2.
Abhulimhen-Iyoha BI, Okolo AA. Morbidity and mortality of childhood illnesses at the emergency paediatric unit of the University of Benin Teaching Hospital, Benin City. Niger J Paed 2012;39:71-4.  Back to cited text no. 2
    
3.
Bamgboye EA, Familusi JB. Mortality pattern at a children′s emergency ward, University College Hospital, Ibadan, Nigeria. Afr J Med Med Sci 1990;9:127-32.  Back to cited text no. 3
    
4.
Ibeziako SN, Ibekwe RC. Pattern and outcome of admissions in the Children′s Emergency Room of the University of Nigeria Teaching Hospital, Enugu. Niger J Paediatr 2002; 29:103-7.  Back to cited text no. 4
    
5.
Sacarlal J, Nhacolo AQ, Sigaúque B, Nhalungo DA, Abacassamo F, Sacoor CN, et al. A 10 year study of the cause of death in children under 15 years in Manhiça, Mozambique. BMC Public Health 2009;9:67.  Back to cited text no. 5
    
6.
Park K. Indicators of health. In: Park K, editor. Park′s Textbook of Preventive and Social Medicine. 17 th ed. Jabalpur, India: M/s.Banarsidas Bhanot Publishers; 2002:21-4.  Back to cited text no. 6
    
7.
Roy RN, Nandy S, Shrivastava P, Chakraborty A, Dasgupta M, Kundu TK. Mortality pattern of hospitalized children in a tertiary care hospital of Kolkata. Indian J Community Med 2008; 33:187-9.  Back to cited text no. 7
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8.
Duru C, Peterside O, Akimbami F.Pattern and outcome of admissions as seen in the PaediatricEmergency Ward of the Niger Delta University Teaching Hospital Bayelsa State, Nigeria. Niger J Paediatr 2013; 40:232-7.  Back to cited text no. 8
    
9.
Fajolu IB, Egri-Okwaji MTC. Childhood mortality in children emergency centre of the Lagos University Teaching Hospital. Niger J Paediatr 2011;38:131-35.  Back to cited text no. 9
    
10.
Wammanda RD, Ali FU. Conditions associated with the risk of death within 24 hours of admission in Zaria, Nigeria. Ann Afr Med 2004;3:134-7.  Back to cited text no. 10
    
11.
Krug A, Patrick M, Pattinson RC, Stephen C. Childhood death auditing to improve paediatric care. Acta Paediatr 2006; 95: 1467-73.  Back to cited text no. 11
    
12.
Mouneke UV, Ibekwe RC, Eke CB, Ibekwe MU, Chinawa JM. Mortality among paediatric inpatients in Mile 4 Mission Hospital Abakaliki, south-eastern Nigeria: A retrospective study. Niger J Paediatr 2013; 40:259-63.  Back to cited text no. 12
    
13.
Okechukwu AA. Discharge against medical advice in children at the university of Abuja teaching hospital, Gwagwalada, Abuja. J Med Sci 2011; 2:949-54.  Back to cited text no. 13
    
14.
Onyiriuka AN. Pediatric discharges against medical advice: Experience from a Nigerian secondary health care institution. Med J Islam Repub Iran 2011; 25:194-99.  Back to cited text no. 14
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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