during the dry season. It has been shown that unsafe
drinking water and poor environmental sa1n9itation con-
tribute significantly to childhood diarrhoea.
Antia-obong in Calabar has suggested late presenta-
tion in the hospital as one of the major contributing fac-
tors to high childhood mortality in our environment.
This is certainly a possibility as our hospital is the only
tertiary centre in the community and subserves other
primary and secondary health centres. Also accessibility
from most of the neighbouring communities is a chal-
lenge as the only source of transport from most of these
communities is1b5 y sea due to lack of roads. Ac2c5ording to
Olusegun et al in Nigeria and Mondal et al in Bang-
ladesh, contributors to child mortality includes accessi-
bility to health care services and the risk of child mortal-
ity decreases with wider access to safe treatment places.
Respiratory tract infections showed peak occurrences in
the months of March, July and October whic2h0 corre-
sponds to the peak of the rainy season. Akanbi in Be-
nin similarly reported more episodes of respiratory tract
infections in t3he rainy season which was in contrast to
Singhi et al who noted more cases in December/
January. Along with malaria and acute diarrheal disease,
it is one of the major 3c,a2u0,s2e1s of under-five mortality
alone or in combination.
The outcome of admissions show a good transfer rate
out of the Emergency ward as well as a good discharge
rate which was similar to findings in other studies in
Nigeria. The rate of discharges against medical advice
in the present series (5.241%) was notably lower than re-
ports from Okechukwu in Abuja (7.4%) and Onyiriuka
in Benin(6.3%). Possible explanations for the lower
Infectious diseases are the major causes of childhood
admissions in our environment. Achievement of the
Millennium Development Goal 4 of reducing child
rates of DAMA in our series could be the fact that neo-
nates were not included in our study unlike the others.
Though in this study, no reasons were given for the de-
sire of the parents to DAMA, poverty a5,n2d1, 2i2gnorance as
contributing factors have been reported.
mortality by two-thirds from the 1990 rate will depend
on renewed efforts to prevent and control malaria, acute
respiratory infections and diarrhoea in the African re-
gion. Health intervention programmes such as the
I26ntegrated Management of27Childhood Illnesses (IMCI),
and Primary health care which have been shown to
significantly reduce childhood morbidity need to be
This study revealed an overall mortality rate of 7.6%,
w9 hich is lower than the 8.4% reported by Adeboye et al
though neonatal mortality was inclusive in their study.
Abhulimhen-Iyoha and Okolo in Beninreported a rate
of 4.4% while Ibeziako and Ibekwe reported 5.1% from
Enugu. The reason for the comparably higher mortality
rate in the present series is not immediately clear but
may be due to environmental factors as the hospitals in
the Benin and Enugu series were both located in urban
centres as opposed to the present series where the hospi-
tal is locat2e3d in a rural area. According to Mesike and
Mojekwu, environmental risk factors account for one-
fifth of the to1t3al disease burden in low income countries.
Singhi et al in India compared the outcome of Paedi-
atric emergency patients in an urban versus a rural hos-
pital. They found that mortality was higher in the rural
Chika D collected the data, analyzed it and wrote the
manuscript. Oliemen Peterside conceived the study and
revised the manuscript. Felix Akinbami revised the
manuscript and supervised the conduct of the study.
Conflict of interest: None
Peak mortality was noted in the ages of 12 to 59 months
We acknowledge the contributions of the doctors and
the nurses of the Children’s Emergency ward of the hos-
pital in the management of these patients. We are also
grateful to the record officers of the unit for their assis-
whic4h was in contrast to findings from Enugu andCala-
bar where peak mortality was noted in the 7 to 12
month age groups. We were unable to determine the
causes of this high mortality from our study; however
WHO/MDG4 Reduce Child Mor-
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millennium_ development_ goals/
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