Journal of tropical pediatrics · 2013
Prevalence and burden of diseases presenting to a general pediatrics ward in Gondar, Ethiopia.
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Gordon David M, Frenning Sarah, Draper Heather R, Kokeb Mehretie
Аннотация
BACKGROUND: Little is known about pediatric hospital admissions in Ethiopia.
METHODS: This cross-sectional study analyzed all data entered into the Gondar University Hospital pediatric ward's admission registration books over 1 year. Patient age, sex, origin, length of stay, diagnosis and discharge condition were transcribed into an electronic database for all observations. Missing data were retrieved by chart and death certificate review. Primary outcome measures included death and death in the first 24 h of admission.
RESULTS: In all, 1927 patients were admitted to our facility during the year of study. Of these, 64.5% improved, 4.6% were discharged unchanged, 6.5% disappeared and 7.5% died; the remaining 17.0% of outcome data were registered as 'non-death' but could not be specified further. The median age of admission was 2.2 years (interquartile range 1-7 years), with more admissions for children younger than 5 years (70.3%) and more male subjects admitted than female subjects (59.6% male). The median length of stay was 4.0 days (interquartile range 2-10 days). Eighty-one percent of admissions originated from Gondar or its neighboring districts. Most admissions carried a respiratory, nutritional or infectious diagnosis (47.5, 46.8 and 36.5%, respectively). Conditions diagnosed most commonly (>200 cases) included community-acquired pneumonia (812 cases), severe acute malnutrition (381), anemia (274) and acute gastroenteritis (219). Seven diagnoses were associated with mortality after adjusting for demographic covariates: severe acute malnutrition (odds ratio (OR) 2.5, P < 0.001), coma (OR 4.2, P < 0.001), meningitis (OR 2.3, P = 0.018), congestive heart failure (OR 2.4, P = 0.001), severe dehydration (OR 2.5, P = 0.004), aspiration pneumonia (OR 5.4, P < 0.001) and sepsis (OR 3.2, P < 0.001). Thirty-three percent of deaths occurred in the first 24 h of admission, with four diagnoses associated with first-24-h mortality after adjusting for demographic covariates: coma (OR 7.0, P < 0.001), meningitis (OR 3.2, P = 0.008), congestive heart failure (OR 3.1, P = 0.008) and aspiration pneumonia (OR 12.1, P < 0.001).
CONCLUSIONS: This study demonstrates a mortality pattern at our hospital that differs considerably from Ethiopia as a whole, and may differ from other hospitals in sub-Saharan Africa. Hospitals must look beyond national and regional agenda when identifying mortality reduction targets.
METHODS: This cross-sectional study analyzed all data entered into the Gondar University Hospital pediatric ward's admission registration books over 1 year. Patient age, sex, origin, length of stay, diagnosis and discharge condition were transcribed into an electronic database for all observations. Missing data were retrieved by chart and death certificate review. Primary outcome measures included death and death in the first 24 h of admission.
RESULTS: In all, 1927 patients were admitted to our facility during the year of study. Of these, 64.5% improved, 4.6% were discharged unchanged, 6.5% disappeared and 7.5% died; the remaining 17.0% of outcome data were registered as 'non-death' but could not be specified further. The median age of admission was 2.2 years (interquartile range 1-7 years), with more admissions for children younger than 5 years (70.3%) and more male subjects admitted than female subjects (59.6% male). The median length of stay was 4.0 days (interquartile range 2-10 days). Eighty-one percent of admissions originated from Gondar or its neighboring districts. Most admissions carried a respiratory, nutritional or infectious diagnosis (47.5, 46.8 and 36.5%, respectively). Conditions diagnosed most commonly (>200 cases) included community-acquired pneumonia (812 cases), severe acute malnutrition (381), anemia (274) and acute gastroenteritis (219). Seven diagnoses were associated with mortality after adjusting for demographic covariates: severe acute malnutrition (odds ratio (OR) 2.5, P < 0.001), coma (OR 4.2, P < 0.001), meningitis (OR 2.3, P = 0.018), congestive heart failure (OR 2.4, P = 0.001), severe dehydration (OR 2.5, P = 0.004), aspiration pneumonia (OR 5.4, P < 0.001) and sepsis (OR 3.2, P < 0.001). Thirty-three percent of deaths occurred in the first 24 h of admission, with four diagnoses associated with first-24-h mortality after adjusting for demographic covariates: coma (OR 7.0, P < 0.001), meningitis (OR 3.2, P = 0.008), congestive heart failure (OR 3.1, P = 0.008) and aspiration pneumonia (OR 12.1, P < 0.001).
CONCLUSIONS: This study demonstrates a mortality pattern at our hospital that differs considerably from Ethiopia as a whole, and may differ from other hospitals in sub-Saharan Africa. Hospitals must look beyond national and regional agenda when identifying mortality reduction targets.