Predictors of early mortality among children under 5 years of age at the Pediatric wards, Mulago hospital

Abstract

Background: In-hospital Pediatric mortality rates are high throughout Sub- Saharan Africa, with most deaths occurring within 48 hours of admission to the hospital. Whereas disease targeted in-hospital child mortality has been reported in several studies, there is a lack of data on overall early under-five mortality in hospitalized children and its predictors. Understanding the characteristics of children who are likely to die early would be useful in designing interventions to reduce mortality in hospitalized children. Objective: The study sought to determine the incidence of early mortality and describe the factors that are associated with death in children 0-59months old in the first 48 hours of admission at the Pediatric Wards), Mulago hospital. Methods: It was a retrospective cohort study involving 3940 patient records. Consecutive sampling was used to select files from the ACU registry. Data of all admissions for under five-year-old children between January to December 2018 was collected electronically using the open data kit (ODK) platform. Information obtained included the child’s socio-demographic characteristics, symptoms, clinical examination findings, investigations and the admission diagnosis. Data was checked for completeness before storing it to the main database, the database was then exported as an excel file into STATA 15.1/MP for analysis. Time to event (death) was determined by subtracting the date and time of death from the date and time of admission. Incidence rate was determined by the number of death that occurred within 48 hours after admission divided by total number of the participants multiplied by 100. The factors associated with mortality were determined by use of COX-PH model at both bivariate and multivariate levels to determine the crude and adjusted Hazard ratios with their corresponding 95% confidence intervals and P values. Factors that had P<0.2 at bivariate were considered for xii multivariate, confounding was considered if the difference in crude and adjusted models was greater than 10%. Results: Out of the 3940 files of patients aged under 59 months who were admitted at the Pediatric Wards, 282 (7.2%) early deaths occurred in the first 48 hours of hospitalization. Multivariate analysis revealed that age in months of 0-11(AHR:9.75;95%CI:1.35-70.33,p=0.024*), 12-23 months (AHR:10.92;95%CI:1.49-80.23,p=0.019*) being referred (AHR:1.55;95%CI:1.01-2.38),P=0.043, having altered level of consciousness (AHR:4.01;95%CI:2.39-6.73,p=<0.01),shock (AHR:5.45;95%CI:2.92-10.15,p=<0.001) and respiratory distress (AHR:2.34;95%CI:1.52-3.60, p=<0.01)were significantly associated with early mortality, while caretakers employment was protective (AHR:0.38; 95%CI:0.26-0.55,P=<0.01). Conclusions: The incidence of early mortality at the pediatric Wards of Mulago National Referral hospital is high. Age in months of 0-11,12-23,Altered level of consciousness, shock, respiratory distress were significantly associated with early mortality, while caretaker being employed was protective. Clinicians should pay particular attention to critically ill children who are comatose, have respiratory distress and those who have been referred since they are more likely to die in the first 48 hours of hospitalization.