|Year : 2014 | Volume
| Issue : 1 | Page : 15-19
Pattern of medical childhood morbidity and mortality in a new specialist hospital in Gusau, Nigeria
Garba I Bilkisu1, Muhammad S Aminu2, Onazi O Sunday3, Edem Bassey1, Aghadueki Smart1, Adelakun B Muyideen1
1 Department of Paediatrics, Yariman Bakura Specialist Hospital, Gusau, Nigeria
2 Department of Medicine, Yariman Bakura Specialist Hospital, Gusau, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Gusau, Nigeria
|Date of Web Publication||18-Sep-2014|
Muhammad S Aminu
Department of Medicine, Yariman Bakura Specialist Hospital, Gusau
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Pattern of hospital admissions and mortality can be a valuable tool in auditing hospital performance. Medical childhood morbidity and mortality in developing countries are high; there has been no reported hospital audit of paediatric admissions in Gusau, Zamfara State.
Aim: We undertook the first hospital audit of paediatric medical admissions at Yariman Bakura Specialist Hospital, Gusau to evaluate the morbidity and mortality pattern.
Materials and Methods: This is a descriptive, cross-sectional study involving postneonatal children aged 1 month to 12 years 11 months, admitted and managed in the paediatric medical wards between April 1, 2013 and March 31, 2014.
Results: Of the 801 children admitted over the study period, 449 (56.1%) were males; with a male: female ratio of 1.3:1. Children under the age of 5 years accounted for 64.9% of the admissions. The common diagnosis was infectious; with malaria, Diarrhoea, sepsis and pneumonia as the most common. Mortality rate was 11.2%, and 1.9% were discharged against medical advice. Malaria, sepsis, diarrhea and pneumonia were the major cause of death in under fives. Malaria, sepsis and seizure disorder were the commonest cause of death in children >5 years. There was no association between mortality and gender (p = 0.320). Children under 5 years were more likely to die than those over 5 years (odds ratio-1.5; 95% confidence interval (1.1-2.5); p = 0.035).
Conclusion: The morbidity and mortality pattern of children in Gusau is similar to what has been reported in other studies. There is a need for more effort by the stakeholders in the health sector to ensure adequate vaccination of children and provision of essential drugs in health care centers in Zamfara state.
Keywords: Childhood, morbidity, mortality, Gusau, Nigeria
|How to cite this article:|
Bilkisu GI, Aminu MS, Sunday OO, Bassey E, Smart A, Muyideen AB. Pattern of medical childhood morbidity and mortality in a new specialist hospital in Gusau, Nigeria. Ann Nigerian Med 2014;8:15-9
|How to cite this URL:|
Bilkisu GI, Aminu MS, Sunday OO, Bassey E, Smart A, Muyideen AB. Pattern of medical childhood morbidity and mortality in a new specialist hospital in Gusau, Nigeria. Ann Nigerian Med [serial online] 2014 [cited 2018 Oct 23];8:15-9. Available from: http://www.anmjournal.com/text.asp?2014/8/1/15/141024
| Introduction|| |
Pattern of hospital admissions and mortality can be valuable in auditing hospital performance. This will be useful in assessing the quality of service and prioritization of health care services in any given health institution.
Medical childhood morbidity and mortality in developing countries are high; and several studies indicate that children in developing countries suffer from infectious and vaccine preventable diseases which lead to significant mortality. ,, These deaths are preventable with available health interventions and technology. The most common childhood killers have been identified to be diarrhoea, measles, tetanus, tuberculosis, malaria, and human immune deficiency virus. ,,,,
Diseases in most developing countries are usually under-reported, and most data obtained are hospital based. Admissions into our emergency paediatric unit (EPU) and paediatric medical wards (PMW) are mostly due to infections; of which vaccine preventable illnesses carry a large chunk. There has been no reported hospital audit of paediatric admissions in Gusau, Zamfara State. It is in this respect that we undertook the first hospital audit of paediatric medical admissions at Yariman Bakura Specialist Hospital (YBSH), Gusau to evaluate the morbidity and mortality pattern.
| Materials and Methods|| |
This study was conducted at YBSH, Gusau located in North Western Nigeria. Gusau is in the southern part of Zamfara State with a mean annual rainfall of about 990 mm and the vegetation being northern guinea savannah type. The hospital is the specialist hospital of the Zamfara State Government, Nigeria, and it started clinical work in March, 2013. It serves as a secondary and tertiary care center for the state capital, as well as a referral center for all the local government areas of the state.
This study is descriptive, cross-sectional and retrospective; involving postneonatal children aged 1 month to 12 years 11 months, admitted and managed in the EPU and PMW between April 1, 2013 and March 31, 2014. Children with surgical conditions were excluded as they are managed by the surgeons and not managed in our units.
The patients were managed by 3 Paediatricians and 7 medical officers. Case files of the patients were retrieved, and a structured questionnaire was used to collect relevant information which included age, gender, definitive diagnosis (those with complete investigations) or probable diagnosis (those without complete investigations or died early), duration of hospital stay and outcome. Outcome was categorized as discharge, death, referred, discharged against medical advice (DAMA) and absconded. Socioeconomic status was not included as this was not documented in all files.
Ethical approval was obtained was obtained from the Ethical Committee of YBSH, Gusau.
Data was analysed with Statistical Package for Social Sciences version 16.0 (SPSS Inc., Chicago, IL, USA) for cleaning and analysis using standard methods. Quantitative variables were summarized using mean and standard deviation. Categorical variables were summarized using frequency and percentages. Chi-square test and Fisher' exact test (for sample size <5 in a cell or more) were used to determine associations between categorical variables. A p < 0.05 was considered statistically significant.
| Results|| |
A total of 801 children were admitted over the study period, of these, 449 (56.1%) were males, and 352 (43.9%) were females with a male:female ratio of 1.3:1. Mean age was 49.40 ± 39.29 months, with the youngest 1 month old, and the oldest 155 months old (12 years, 11 months).
Five hundred and twenty (64.9%) of the children were under 5 years, of which majority were males as shown in [Table 1].
The common diagnoses on presentation were infectious; with malaria, diarrhoea, sepsis and pneumonia being the commonest diagnoses as shown in [Table 2]. Febrile convulsions were mostly due to malaria, pharyngotonsillitis and pneumonia. Most of the seizure disorders were generalized seizures (tonic-clonic).
Children under 5 years old accounted for 100% of children with measles, 90.6% of protein energy malnutrition, 88.5% of diarrhea, 85.4% of pneumonia, 68.0% of sepsis, 64.3% of malaria, and 57.1% of cholera cases. Children above the age of 5 years accounted for 100% of snake bites, 84.0% of typhoid sepsis, 83.3% of nephrotic syndrome and 63.9% of sickle cell anemia cases with various crises and complications.
Majority of the children were discharged as shown in [Figure 1]. Mortality rate was 11.2%, and 1.9% of the children's caregivers DAMA.
Most of the mortality occurred in males as shown in [Table 3]. However, there was no significant association between mortality and gender (χ2 = 1.01, p = 0.320). Children under 5 years where more likely to die than those over 5 years (odds ratio-1.5; 95% confidence interval (1.1-2.5); p = 0.035).
The causes of death in under fives and children above the age of 5 years are shown in [Table 4] and [Table 5] respectively. Malaria was the commonest cause of death in both age groups.
Forty (44.4%) of the deaths occurred within the first 24 h of admission, while 50 (55.6%) occurred after 24 h of admission.
| Discussion|| |
Our hospital is new, but despite this; there was a high-number of morbidity within the 1 st year of clinical services. This could be explained by the fact that it is the only state-owned tertiary hospital and because it is new people want to have an experience of the new hospital.
The first paediatric hospital audit of medical morbidity showed more males were admitted than females. The male preponderance of hospital admission has been documented in various other studies. ,,,,,, Reason for this could be related to the biological vulnerability of males to infection.
Majority of the children were under the age of 5 years which is also similar to what has been found in Port Harcourt,  Benin,  Ilorin,  Niger Delta,  Ilesa  and Abuja.  This could be due to the vulnerability of this age group as a result of incomplete immunity against infections.
Malaria, diarrhoea disease, sepsis, pneumonia and protein energy malnutrition were the commonest diseases seen in our hospital. These are similar to what was observed in Port Harcourt,  Benin,  Owerri,  Imo,  Ilesa,  Abuja,  and Kenya.  Measles was common in our study unlike what was seen in Benin.  These findings have shown that morbidity pattern in Nigerian children has persistently remained the same over decades. This may be due to poor socioeconomic conditions, and lack of or incomplete immunization.
There was a high prevalence of cholera and enteric fever which is a reflection of poor sanitary conditions and unhygienic water supply. The number of children with enteric fever is higher than what was reported by George and Tabansi  in Port Harcourt. Most studies did not report on cholera; probably they were considered as gastroenteritis. There was an epidemic of cholera during the study period which could be responsible for the high number of cases seen in our study. However, there was no recorded death from the cases managed with cholera.
More than 85% of the children were discharged; this is similar to what was observed by Ugwu  and Iloh et al. Our DAMA was lower than what was observed by Ugwu in Niger delta  and Iloh et al.  in Imo, but higher than what Ibeziako and Ibekwe  obtained in Enugu. Our mortality rate is in consonance to that obtained in Lagos,  Ilorin,  and Kaduna  but is higher than what was observed in Port Harcourt,  Ilorin,  Enugu,  Niger delta,  Kenya,  Zaria,  Latur.  It is however, lower than what was found by Okechukwu and Nwalozie in Abuja  and Wammanda and Alli  in Zaria a decade ago. Reasons for these differences in outcome could be due to methodology as some studies were conducted in both neonatal and postneonatal children, some included surgical patients; and also, the duration of study periods vary. Another reason could be the type of hospital and presence of other referral hospitals in the state.
Most of the deaths occurred in children under the age of five, which is similar to what was observed in some studies. ,,,,, Majority of the death occurred after 24 h which is also similar to what has been found in some studies. , This is in contrast to what was found in Lagos,  Ilorin,  Kenya,  Zaria  and Latur.  More males died than females which could be due to the fact that there were more males admitted during the study period. This was also observed in Port Harcourt,  Ilorin,  Ibadan,  Latur,  and India. 
Common causes of death is similar to what was observed by Abhulimhen-Iyoha and Okolo  in Benin Fajolu and Egri-Okwaji  in Lagos and other studies. ,,,,, Causes of death in our under five children is similar to what was found in Port Harcourt.  These still shows infections (especially malaria, pneumonia and diarrhea) and malnutrition are still the leading causes of childhood mortality. There is a need to intensify improvement in hygiene, sanitation, clean water and strengthening of immunization.
Death from human immunodeficiency virus (HIV) infection was uncommon in our study; as no patient died from the infection. This has contrasted what was observed by George and Tabansi  and George et al.  in Port Harcourt. Reason for this may be that, Zamfara state has one of the lowest HIV prevalence in Nigeria. 
| Conclusion|| |
The morbidity and mortality pattern of children in Gusau is similar to what has been reported in other parts of Nigeria and in India. The study being a retrospective study had the limitations of not including socioeconomic and immunization statuses of the children. Despite this, the high morbidity and mortality from infections and vaccine preventable diseases especially in children under 5 years of age was high and unacceptable, thus making achieving millennium development goals a mirage. There is a need for intensification and a more focused effort by the government and development partners to ensure adequate vaccination, sanitation, and provision of essential drugs in health care centers across the country. Health education on preventive strategies such as exclusive breastfeeding, provision of clean water, completing immunization, improvement in personal hygiene and environmental sanitation, prevention of malaria using insecticide-treated bed nets should be disseminated regularly by the media.
| Acknowledgments|| |
We thank Dr. Abdullahi Musa of Department of Pediatrics, Ahmadu Bello University Zaria, for his contributions.
| References|| |
|1.||George IO, Tabansi PN. An audit of cases in the children emergency ward in a Nigerian Tertiary Tospital. Pak J Med Sci 2010;26:740-3. |
|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 Paediatr 2012;39:1-74. |
|3.||Fajolu IB, Egri-Okwaji MT. Childhood mortality in children emergency centre of the Lagos University Teaching Hospital. Niger J Paediatr 2011;38:131-5. |
|4.||George IO, Alex-Hart BA, Frank-Briggs AI. Mortality pattern in children: A hospital based study in Nigeria. Int J Biomed Sci 2009;5:369-72. |
|5.||Fagbule D, Joiner KT. Pattern of childhood mortality at the University of Ilorin Teaching Hospital. Niger J Paediatr 1987;14:1-5. |
|6.||Ayoola OO, Orimadegun AE, Akinsola AK, Osinusi K. A five-year review of childhood mortality at the University College Hospital, Ibadan. West Afr J Med 2005;24:175-9. |
|7.||Nwolisa CE, Erinaugha AU, Ofoleta SI. Pattern of morbidity among pre-school children attending the children's outpatient clinic of Federal Medical Centre Owerri, Nigeria. Niger J Med 2005;14:378-80. |
|8.||Adeboye MA, Ojuawo A, Ernest SK, Fadeyi A, Salisu OT. Mortality pattern within twenty-four hours of emergency paediatric admission in a resource-poor nation health facility. West Afr J Med 2010;29:249-52. |
|9.||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. |
|10.||Ugwu GI. Pattern and outcome of paediatric admission in a tertiary hospital in the Niger delta region of Nigeria: A two year prospective study. Int J Med Appl Sci 2012;1:15-29. |
|11.||Iloh GU, Ofoedu JN, Njoku PU, Amadi AN, Godswill-Uko EU. The Magnitude of Under-five Emergencies in a Resource-poor Environment of a Rural Hospital in Eastern Nigeria: Implication for Strengthening the House-hold and Community-integrated Management of Childhood Illnesses. N Am J Med Sci 2012;4:344-9. |
|12.||Sule SS. Childhood morbidity and treatment pattern at the multipurpose health centre, Ilesa, Nigeria. Niger J Med 2003;12:145-9. |
|13.||Okechukwu AA, Nwalozie C. Morbidity and mortality pattern of admissions into the Emergency Paediatric Unit of University of Abuja Teaching Hospital, Gwagwalada. Niger J Med 2011;20:109-13. |
|14.||Menge I, Esamai F, van Reken D, Anabwani G. Paediatric morbidity and mortality at the Eldoret District Hospital, Kenya. East Afr Med J 1995;72:165-9. |
|15.||Abdurrahman MB. Why our children die: A study of mortality pattern in an emergency paediatric unit in Kaduna, Nigeria. Niger Med Pract 1983;5:157-62. |
|16.||Aikhionbare HA, Yakubu AM, Naida AM. Mortality pattern in the Emergency Paediatric Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Cent Afr J Med 1989;35:393-6. |
|17.||Patil SW, Godele LB. Mortality pattern of hospitalised children in a tertiary care hospital in Latur: A record based retrospective analysis. Natl J Community Med 2013;4:96-9. |
|18.||Wammanda RD, Alli FU. Conditions associated with the risk of death within 24 h of admission in Zaria, Nigeria. Ann Afr Med 2004;3:134-7. |
|19.||Chawla V, Haufton B. Pattern of childhood mortality at Harare Central Hospital, Zimbabwe. East Afr Med J 1988;65:238-45. |
|20.||Roy RN, Nandy S, Shrivastara P, Chakraboty A, Das gupta M, Kundu TK. Mortality pattern of hospitalised children in a tertiary care hospital in Kolkota. Indian J Community Med 2008;33:187-9. |
|21.||HIV/AIDS statistics in Nigeria 2014-State by State analysis. Ng Newspapers. Jan 28, 2014. Available from: http//www.ngnewspapers.com/hivaids-statistics. [Last accessed on 2014 May 14]. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]