Paediatric deaths in a tertiary government hospital setting, Malawi
Paediatric deaths in a tertiary government hospital setting, Malawi
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DOI：
10.1080/20469047.2018.1536873
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发表时间：
2019-10-02
影响因子：
1.8
通讯作者：
Kennedy, Neil
中科院分区：
文献类型：
--
作者：
Harris, Caroline;Mills, Rowena;Kennedy, Neil
背景：马拉维成功实现了千年发展目标4，2012年将5岁以下儿童死亡率降低了三分之二。尽管取得了这一进展，儿童死亡率仍然很高，2013年，5岁以下儿童死亡的主要原因是疟疾、急性呼吸道感染和艾滋病毒/艾滋病。目的：确定马拉维住院儿童死亡的原因，包括微生物病因。方法：2015/2016年在伊丽莎白女王中央医院进行了为期12个月的前瞻性描述性研究。收集了每个儿科患者的数据，包括艾滋病毒和营养状况、死亡原因和微生物学。排除了先天性新生儿死亡。结果：在13，827例住院患者中，有488例死亡，死亡率为3.5%。三分之一的死亡（168人）发生在入院后24小时内，255人在48小时后死亡。五个主要死因是败血症（102人）、下呼吸道感染（67人）、急性胃肠炎伴严重脱水（51人）、疟疾（37人）和脑膜炎（34人）。主要的非传染性死亡原因是实体瘤（12）。在362名已知艾滋病毒感染状况的儿童中，134名（37.0%）感染艾滋病毒或暴露于艾滋病毒。在已知营养状况的429名儿童中，93名有严重急性营养不良的证据。252例患儿血培养51例（20.2%）检出致病菌，其中肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌最常见。结论：尽管马拉维的儿科住院死亡率显著下降，但传染病仍然是主要原因。
Background: Malawisuccessfully achieved Millennium Development Goal (MDG) four by decreasing the under-5 mortality rate by two-thirds in 2012. Despite this progress child mortality is still high and in 2013, the leading causes of death in under-5s were malaria, acute respiratory infections and HIV/AIDS. Aims: To determine the causes of inpatient child death including microbiological aetiologies in Malawi. Methods: A prospective, descriptive study was undertaken in Queen Elizabeth Central Hospital over 12 months in 2015/2016. Data was collected for every paediatric covering HIV and nutritional status, cause of death, and microbiology. Deaths of inborn neonates were excluded. Results: Of 13,827 admissions, there were 488 deaths, giving a mortality rate of 3.5%. One-third of deaths (168) occurred in the first 24 h of admission and 255 after 48 h Sixty-eight per cent of those who died (332) were under 5 years of age. The five leading causes of death were sepsis (102), lower respiratory tract infection (67), acute gastroenteritis with severe dehydration (51), malaria (37) and meningitis (34). The leading non-communicable cause of death was solid tumour (12). Of the 362 children with a known HIV status 134 (37.0%) were HIV-infected or HIV-exposed. Of the 429 children with a known nutrional status, 93 had evidence of severe acute malnutrition (SAM). Blood cultures were obtained from 252 children 51 (20.2%) grew pathogenic bacteria with Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus being the most common. Conclusion: Despite a significant reduction in paediatric inpatient mortality in Malawi, infectious diseases remain the predominant cause.