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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