Nigerian Journal of
Paediatrics 2011;38(3)131 - 135
ORIGINAL
Fajolu IB,
Childhood mortality in children
Egri-Okwaji MTC.
emergency centre of the Lagos University
Teaching hospital
Received: 9th September
2011
Abstract
Background: Infant
and
children admitted
during the study
Accepted:23rd September
2011
childhood mortality has
remained
Period died, giving a
mortality of
high in developing
countries like
11.1%. More than half
of the deaths
Fajolu IB, (
)
Nigeria with only
marginal
(55.4%) occurred within
24hours of
Egri-Okwaji MTC.
reductions achieved
over the past
arrival in hospital.
Neonates
Department of
Paediatrics
two decades despite
several
accounted for 54.7% of
deaths.
University Teaching
Hospital,
interventions to reduce
morbidity
The common causes of
death in the
College of Medicine
University of
and mortality from the
common
neonates were perinatal
asphyxia
Lagos. Nigeria
causes of death in
children. It is
(36.1%), neonatal
jaundice
therefore important to
examine the
(21.3%), prematurity
(16.3%) and
current pattern of
mortality in
septicaemia (11.5%),
while in the
children and compare it
with
o l d e r
c h i l d r e n
a n a e m i a ,
previous reports from
this centre so
septicaemia, severe
malaria and
as to determine if
newer
acute respiratory
illnesses were the
interventions are
needed or if these
commonest conditions
accounting
current interventions
need to be
for 22.6%, 16.3%, 12.1%
and 9.9%
strengthened for more
effective
of deaths
respectively.
reduction in childhood
mortality.
Conclusion: Childhood
mortality in
Objective: The
aim of
this study
LUTH is still high with
majority of
was to examine the
pattern of
deaths occurring in
infancy
childhood mortality in
the children
especially in the
neonatal period.
emergency centre of the
Lagos
Efforts to prevent
perinatal
University Teaching
Hospital
asphyxia, the most
common cause
(LUTH).
of death in the
neonatal period,
M a
t e r i a l s
a n
d
M e
t h o d s :
should be intensified
and education
Admission and discharge
records
o n
t h e
p r e v e n t i o n
,
e a r l y
from October 2007 to
November
identification and
management of
2 0 0 8
w e r e
r e v i e w e d
conditions such as
neonatal
retrospectively, the
age, sex,
jaundice, malaria,
anaemia and
diagnosis and duration
of hospital
acute respiratory
illnesses should
stay before death were
analyzed.
also be
strengthened.
Results: Four
hundred and
forty six
children (446) out of
the 4031
Introduction
The average annual
reduction in the under five
mortality rate from
1990-2007 for Nigeria was 1.2%
compared with 3.0% for
the industrialized countries .
1
Despite the various
intervention programs to
improve child survival
such as baby friendly
Factors responsible for
this include among others
initiative, control of
diarrhoeal disease,
poor utilization of
available health services and when
they are utilized
patients present late
2,3
immunization
programmes, roll back malaria etc,
with 40.1% -
the childhood mortality
rates in most developing
64.2% of deaths
occurring within 24 hours of arrival
in the hospital.
4-6
countries have remained
high with only marginal
The common causes of
death in
reductions achieved
over the past two decades.
children especially in
the developing countries are
still largely
preventable diseases such as perinatal
asphyxia,
septicaemia,
REVIEW
132
acute respiratory
illnesses, diarrhoea and malaria.
Table 1: Mortality rate in the different age
groups
An earlier study done
in this centre in 1990 reported
Age group
Total no of
Total no of
a mortality rate of
14.3% in children in the
admissions
deaths (%)
emergency room, and
91.5% of these children were
less than five
years.
7
Neonatal age
group<7days
972
222 (22.8)
The major causes of
death in this earlier study were
8-28days
325
22 (6.7)
protein energy
malnutrition, neonatal jaundice,
Post neonatal age
diarrhoeal diseases,
pneumonia, severe anaemia and
group
1813
150 (8.3)
prematurity.
1-59months
>60months
921
52 (5.6)
This retrospective
study was carried out to examine
Total
4031
446 (11.1)
the current pattern of
childhood mortality at the
children emergency
centre of the Lagos University
Table 2 shows the
duration of admission before death
Teaching Hospital
(LUTH).
with two hundred and
forty seven (55.4%) deaths
occurring within 24
hours of arrival. Forty-six of the
deaths within 24 hours
(18.6%) occurred within the
first 6 hours of
arrival in the hospital. Eight children
had no diagnosis
recorded and were excluded from
Materials and Methods
further
analysis.
Registration,
admissions and discharge records of
Table 2: Duration
of admission
before death
in the
the children emergency
room and case notes of
different age
groups
patients who died in
the children emergency room of
Age
(n)
Duration of admission
the Lagos University
Teaching Hospital from
before death
November 2007 to
October 2008 were reviewed.
<24 hours
>24 hours
Information obtained
included age, sex, clinical and
or laboratory diagnosis
and duration of hospital stay
< 7days (222)
108
114
before death. Data was
presented in numbers and
8-28 days (22)
11
11
percentages, chi square
was used to compare groups,
1-11months (79)
46
33
and a p-value of ≤ 0.05
was considered significant.
12-59 months
(71)
43
28
> 60months
(52)
39
13
Total (446)
247
114
Results
Table 3 shows the
different diseases leading to death
During the 12 month
period of the study, a total of six
in neonates. The major
diseases in the neonatal period
thousand, eight hundred
and fifty nine (6859)
were perinatal asphyxia
(36.1%), neonatal jaundice
children were seen at
the children emergency centre
(21.3%), prematurity
(16.3%) and septicaemia
of LUTH. Four thousand
and thirty one (4031)
(11.5%).
children (M: F
1.5:1) were admitted
and four
hundred and forty-six
(264 male and 182 female)
Table 3: Diseases
resulting in
deaths among
neonates
died in the emergency
room giving an overall
Disease
Number
Percentage
mortality of 11.1%.
Three hundred and ninety-four
Perinatal
asphyxia
88
36.8
(88.3%) of these deaths
were in children under
Neonatal
jaundice
52
21.7
5years of age. More
than half of the total deaths
(54.7%) were in
neonates and 91percent of these
Prematurity
40
16.7
deaths occurred in the
first week of life. Table 1
Sepsis
28
11.7
shows the percentage
mortality amongst admissions
Meningitis
2
0.8
in the different age
groups. In the neonatal age
Anaemia
4
1.6
group, neonates in the
first week of life were more
HIV
3
1.2
likely to die than
those more than 1 week old
Congenital heart
disease
2
0.8
(p=0.000) while in the
post neonatal age group,
Surgical cases
3
1.2
children under 5 years
were more likely to die than
Chromosomal
anomaly
1
0.4
those more than 5 years
(p = 0.01)
Neonatal tetanus
1
0.4
Others
16
6.7
Total
239
100
133
Table 4 shows the
diseases leading to death in
Table 5: Pattern
of disease
causing death
among
children beyond the
neonatal period. Anaemia,
neonates in Lagos
University Teaching Hospital
septicaemia, severe
malaria and acute respiratory
over 18 years
illnesses were the
commonest diseases resulting in
Number (%)
death in children under
1year but outside the neonatal
period accounting for
22.6%, 16.3%, 12.1%
and
Disease
1990*
2008
+
p-value
9.9%
respectively.
Table 4: Diseases
resulting in
death among
children
Neonatal
jaundice
179 (35.3)
52 (21.7)
0.000
outside the neonatal
period
Aspyhxia
64 ((12.6)
88 (36.8)
0.000
Prematurity
78 (15.4)
40 (16.7)
0.636
Diagnosis
Age
in months
Sepsis
62 (12.2)
28 (11.7)
0.840
1-11 n
12-59 n
=60
n
Total n
Neonatal tetanus
73 (14.4)
1 (0.4)
0.000
(%)
(%)
(%
(%)
Others
51 (10.1)
30 (12.7) 0.307
Anaemia
14
20 (28.6)
9
43 ( 21.6)
Total
507
239
(18.2)
(17.3)
Septicaemia
23
8 (11.4)
2 (3.8)
33 (16.6)
* From reference
7
(29.8)
+ Present study
Severe
3 (3.9)
11 (15.7)
12
26 (13.1)
malaria
(23.1)
Table 6: Pattern
of disease
causing death
in the
ARI
15
3 (4.3)
2 (3.8)
20 (10.1)
outside the neonatal
period in Lagos University
(19.5)
Teaching Hospital over
18 years
Meningitis
3 (3.9)
6 (8.6)
2 (3.8 )
11 (5.5)
Number (%)
HIV
6 (7.8)
3 (4.3)
1 (1.9 )
10 (5.0)
Disease
1990*
2008
+
p-value
PEM
2 (2.6)
2 (2.9)
-
4 (2.0)
SCD
-
3 (4.3)
1 (1.9)
4 (2.0)
PEM
211(24.6)
4 (2.0)
0.000
Burns
-
-
3 (5.9)
3 (1.5)
Diarrhoeal
diseases
122 (14.2)
10 (5.0)
0.000
Measles
1 (1.3)
2 ( 2.9)
-
3 (1.5)
ARI
110 (12.8)
20 (10.1)
0.281
Intestinal
-
1 (1.4)
3 (5.9)
4 (2.0)
Severe anaemia
80 (9.3)
43 (21.6)
0.000
obstruction
Malaria
47 (5.5)
26 (13.1)
0.000
Typhoid
-
1 (1.4)
5 (9.6)
6 (3.1)
Septicaemia
35 (4.1)
33 (16.5)
0.000
enteritis
Measles
21 (2.5)
6 (3.0)
0.649
Tetanus
-
-
2 (3.8)
2 (1.0)
HIV
0 (0)
20 (10.1)
0.000
Diarrhoeal
4 (5.2)
5 (7.1)
1 (1.9)
10 (5.0)
Meningitis
40 (4.7)
11 (5.5)
0.610
diseases
Sickle cell
disease
47(5.5)
4 (2.0)
0.061
Malignancy
-
1 (1.4)
2 (3.8)
3 (1.5)
Febrile convulsion
35 (4.1)
0 (0.0)
0.007
Others
6 (7.8)
4 (5.7)
7
17 (8.5)
Others
109 (12.7)
22 (11.1) 0.521
(13.5)
Total
857
199
Total
77
70
52
199
(100.0)
(100.0)
(100.0)
(100.0)
* From reference
7
+ Present study
Tables 5 and 6 show a
comparison of the pattern of
disease causing death
in the neonatal and post
neonatal age groups
respectively over 18 years in
LUTH. Table 5 shows a
significant reduction in the
deaths from neonatal
tetanus and neonatal jaundice
Discussion
from 1990 compared with
the present study while
there was. In the post
neonatal age group, the deaths
This study showed a
mortality of 11.1percent
from PEM, diarrhoeal
diseases, and febrile
amongst children
admitted in the emergency room of
convulsion
significantly reduced, however there was
LUTH during the study
period. This is higher than 9.9
a significant increase
in the deaths from malaria,
percent, 5.1percent and
9.5 percent reported in some
other parts of the
country
6,8,9
severe anaemia,
septicaemia and HIV as shown in
and also higher
than
table 6.
8.2percent and
7.8percent reported in some other
African
countries
2,10
It is however similar
to the
12.6percent reported in
Sagamu over a ten year
period , but lower than
14.3 percent and 15.1percent
11
reported in an earlier
study from this centre and from
7
Zaira
respectively.
4
134
More than half of the
deaths (55.4%) occurred
Present study, a
significant reuction in there was a
within 24 hours of
arrival in hospital, this was higher
significant reduction
in mortality from diarrhoeal
than figures of 40.1%
reported from a recent study in
diseases and protein
energy malnutrition and febrile
Zaria and 43.7%
reported from Zimbabwe.
4
12
An
convulsion in this
study compared to the earlier study
earlier study from
Zaria however reported a figure of
(14.2 to 5 %, 24.6 to 2
% and 4.1 to 0 % for diarrhoeal
57.6% similar to that
in this present study. The
6
diseases, protein
energy malnutrition and febrile
factors that were
significantly associated with deaths
convulsion
respectively) in the post neonatal age
within 24 hours of
admission in the Zaria study
group (Table 6).
included the presence
of seizures before admission,
heart failure, altered
consciousness and moderate to
This reduction could be
attributed to child survival
severe dehydration at
presentation. Delay in
strategies such as
promotion of breastfeeding and use
commencement of
treatment which was promptly
of oral rehydration
solution in management of
prescribed (attributed
to inability of parents to pay
diarrhoea at home
before presenting at the hospital.
for the treatment) was
also significantly associated
There was however a
significant increase mortality
with deaths within 24
hours of admission. This
due to malaria
septicaemia, severe anaemia and HIV
present study however
did not evaluate factors
in the present study
compared to the earlier study.
associated with deaths
within 24 hours of admission.
Possible factors that
may be responsible for this
include poor
socioeconomic and environmental
Neonates accounted for
54.7% of the deaths within
conditions and delay
and or poor management of
the study period,
similar to the 57.3% reported in
these conditions before
presentation in hospital. HIV
Sagamu
11
but higher than figures
of 23.5-37.2%
also accounted for some
deaths in this study while it
reported in Ibadan,
Ilorin and also in an earlier study
did not in the earlier
study; this could be due to the
from this centre
respectively.
13-15
Perinatal
asphyxia
fact that the earlier
study was done when awareness to
was the leading
condition resulting in death in the
HIV infection was just
beginning in the country. The
neonatal age group
(36.1%) in this study and this
contribution of measles
to mortality was however
could be a reflection
of poor utilization of antenatal
similar in both
studies.
and delivery services
or may be due to ignorance of
the birth attendants in
the art of neonatal
In the current state of
neglect of some of the
resuscitation. Neonatal
jaundice, prematurity and
programmes on child
survival, reinforcement could
septicaemia were also
major contributors to neonatal
be necessary to sustain
them and further reduce
mortality in this study
just as had been reported by
mortality.
Interventions such as the roll back malaria,
other studies.
7,10,13,14
It is however
interesting to note
National programme on
immunization (NPI),
as shown in table 5
that neonatal tetanus accounted
prevention of mother to
child transmission (PMTCT)
for only 0.4percent of
deaths among neonates
and early infant
diagnosis (EID) of HIV must all be
compared to the
14.4percent (p = 0.00) reported in an
strengthened to help
reduce childhood mortality in
earlier study also from
this centre. This is probably
11
Nigeria to help Nigeria
move nearer attaining the
because of various
interventions to eradicate
Millennium development
goals.
neonatal tetanus and
this includes improved
One limitation of this
study was the incomplete data
maternal
immunization.
obtained in some of the
cases and this is a known
limitation of
retrospective studies.
There was however an
increase in the percentage of
deaths from perinatal
asphyxia in the present study.
This may be as a result
of lack of access to and poor
utilization of
available health care services and this
Conclusion
may be a pointer to the
need for more healthcare
providers to be trained
in neonatal resuscitation
This study shows that
childhood mortality in LUTH
especially at the
community level. Present ongoing
is still high with more
than of the deaths occurring
efforts in the country
such as the “ Neonatal
within 24 hours of
admission in hospital. Majority of
resuscitation ”
and “ Helping babies
breathe ”
these deaths were in
infancy especially in the early
programmes should be
further intensified to help
neonatal period and the
most common cause of death
reduce deaths from
perinatal asphyxia.
in this period was
perinatal asphyxia. Efforts to
reduce perinatal
asphyxia should be intensified by
Beyond the neonatal
period the commonest diseases
resulting in death were
severe anaemia followed by
ensuring that
deliveries are attended to by personnel
infections, severe
malaria and acute respiratory
who are trained in
neonatal resuscitation. The roll
illnesses. When the
earlier study from this centre by
back malaria programme
should be strengthened and
Lesi et al which looked
at mortality from January
7
PMTCT, EID and
treatment of children with HIV
1989 to December 1990
was compared with the
should be scaled up.
Education on the prevention,
early identification
and management of conditions
such as neonatal
jaundice, malaria, anaemia and acute
respiratory illnesses
should also be strengthened.
135
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