ORIGINAL  
Niger J Paed 2012;39 (2):71 - 74  
Abhulimhen-Iyoha BI Morbidity and mortality of childhood  
Okolo AA  
illnesses at the emergency paediatric  
unit of the University of Benin Teaching  
Hospital, Benin City.  
DOI:http://dx.doi.org/10.4314/njp.v39i2.7  
during the period with over 80%  
being children five years or less.  
Severe malaria accounted for the  
largest number of deaths (29.4%) in  
the unit, followed by meningitis  
Received:10th December 2011  
Accepted: 3rd January 2012  
Abstract Objective: To describe  
the pattern of morbidity and mortal-  
ity as seen at the Emergency Paedi-  
atric Unit of the University of Be-  
nin Teaching Hospital, Benin City.  
Methods: A retrospective study in  
which records of admissions over a  
two-year period were obtained from  
the medical and ward records. In-  
formation retrieved included age,  
sex, diagnosis, duration of stay in  
the unit and outcome.  
Results: A total of 3,261 patients  
aged between 29 days and 16 years  
were admitted into the Children  
Emergency Room during the pe-  
riod. Of these, 1,835 (56.3%) were  
males while 1,426 (43.7%) were  
females. The total number of under-  
fives admitted was 2,289 (70.2% of  
total admissions). The major causes  
of admission were malaria (44.4%),  
respiratory tract infections (17.8%)  
and gastroenteritis with moderate or  
severe dehydration (10.1%). There  
were 992 (30.4%) discharges while  
Abhulimhen-Iyoha B I (  
Okolo A A  
)
(
16.9%) and septicaemia (15.4%)  
Department of Child Health,  
University of Benin Teaching  
Hospital,  
P. M. B. 1111, Benin City.  
E-mail:drblessing4ever@yahoo.com  
with over 80% of the deaths being  
from infectious diseases.  
Conclusion: Infectious diseases are  
still the major causes of morbidity  
and mortality especially in under-  
fives in our locality. The role of  
environmental sanitation, health  
education and good nutrition in the  
health of the child must be brought  
to the fore. The nation's immunisa-  
tion schedule should include vac-  
cines against infectious organisms  
like Haemophilus influenzae and  
Streptococcus pneumoniae which  
are major causes of pneumonia and  
meningitis in childhood. Also, a  
boost in the coverage of our health  
insurance scheme would be a step  
in the right direction.  
Tel: +2348059143792  
Key Words: Pattern, morbidity,  
mortality, Emergency Paediatric  
Unit, admissions.  
2
,126 (65.2%) were transferred  
tothe paediatric wards for further  
management. One hundred and  
forty-three (4.4%) patients died  
4
Introduction  
in August 1976. It is presently a component of the Ac-  
cident and Emergency(A&E) complex of the hospital.  
1
,2  
Under-five mortality in Nigeria is high. However, the  
4
Millennium Develo3pment Goal targets to reduce under-  
The aim of this unit is to provide care for children who  
require prompt life-saving measures after which they are  
discharged as soon as possible from the unit preferably  
within 24 to 48 hours of admission either by transfer to  
the main paediatric wards or home to continue treatment  
as out-patients. The attending paediatrician and nursing  
staff prioritizes all patients according to the severity of  
their condition (Emergency Triage Assessment and  
five mortality rate. An appraisal of the morbidity and  
mortality pattern in our Emergency Paediatric Unit  
would avail us the opportunity to assess our strides in  
working towards this goal.  
Also, child survival efforts can be effective only if they  
are based on accurate information about causes of  
deaths.  
5
Treatment; ETAT) ensuring that the more critically ill  
child is attended to first. This study was undertaken to  
describe the pattern of morbidity and mortality as seen  
in the unit especially since the last audit was done over  
The Emergency Paediatric Unit (EPU) of the University  
of Benin Teaching Hospital (UBTH), Benin City started  
4
3
0 years ago.  
7
2
Patients and Methods  
emergencies, congenital and acquired heart diseases,  
cellulitis, measles with complications, pulmonary tuber-  
culosis, nephrotic syndrome, chronic renal failure, dia-  
betic ketoacidosis, , seen within the study period.  
This retrospective study reviewed the admission and out  
-patient attendance registers of all children seen at the  
EPU of UBTH, Benin City, from January 2009 to De-  
cember 2010. Ward records of all patients seen; admit-  
ted patients, transfers out/ discharges and deaths were  
utilized for the purpose of this study. Data extracted  
from the records included age, sex, diagnosis, duration  
of stay in the unit and outcome as far as the unit is con-  
cerned. Outcome is classified as discharge, transfer to  
the main paediatric wards and death. The duration of  
stay in the unit of the patients who died were also re-  
trieved from the death records. Ethical approval was  
obtained from the Ethics Committee of UBTH.  
Paediatric Acquired Immune Deficiency Syndrome  
(AIDS) constituted 1.6% of the admissions while acci-  
dental poisoning contributed 1.3% (Table 1). Kerosene  
ingestion was the commonest (67.4%) form of poisoning  
followed by alcohol intoxication (11.6%). Four of the  
children with alcohol intoxication were less than three  
years old but one of them was a ten year old. They were  
all males.  
Table 1: Major Causes of Admission into the Children  
Emergency Room  
Diagnosis of malaria was on the basis of the presence of  
asexual forms (trophozoites/ring forms) of malaria para-  
sites and or satisfactory clinical response to antimalarial  
Condition  
No. of  
Patients Admissions  
% of Total  
6
therapy. Bacterial meningitis was defined as a positive  
cerebrospinal fluid (CSF) culture, or bacteria noted on a  
Gram stain. However, prior to presentation, some of the  
Severe malaria  
1449  
44.4  
Respiratory tract infections  
Gastroenteritis  
Haemoglobin-SS Disease  
Meningitis  
582  
329  
245  
112  
109  
53  
52  
51  
43  
236  
3,261  
17.8  
10.1  
7.5  
3.4  
3.3  
1.6  
1.6  
1.6  
1.3  
7
patients with meningitis had received various forms of  
treatment including antibiotic therapy from chemists and  
private medical practitioners. Consequently, cultures of  
CSF were negative in such cases and diagnosis was  
based on clinical findings, biochemical and cytological  
changes in the CSF. Similarly, the diagnosis of septicae-  
mia was based on positive blood cultures and/or clinical  
findings.  
Septicaemia  
Acute severe asthma  
Febrile convulsion  
Paediatric AIDS  
Accidental poisoning  
Miscellaneous  
7.2  
100.0  
Total  
The data obtained were entered into a spreadsheet and  
analysed. Statistical analysis involved calculation of  
percentages, ratios and means.  
Nine hundred and ninety-two patients (30.4%) were  
discharged from the unit after treatment while 2,126  
(
65.2%) were transferred to the main Paediatric wards  
for further management (Table 2).  
Results  
Table 2: Outcome of Admitted Patients  
During the period of the study, 10,044 patients aged  
between birth and 17 years were seen at the out-patient  
section of the EPU (Paediatric Casualty). Of these,  
Outcome  
No. of  
Patients Admissions  
% of Total  
3
,261 patients (32.5%) were admitted into the Children  
Emergency Room (CHER) for in-patient care while  
,783 (67.5%) were treated as out-patients. Of those  
admitted, 1,835 (56.3%) were males while 1,426  
43.7%) were females; giving a M: F ratio of 1.3: 1. The  
Discharged  
Transferred out  
Died  
992  
2126  
143  
30.4  
65.2  
4.4  
6
(
Total  
3261  
100.0  
age range of the admitted patients was 29 days - 17  
years. The total number of under-fives admitted was  
2
in the unit ranged between 10 minutes and six days.  
,289 (70.2% of total admissions). The duration of stay  
One hundred and forty-three (4.4%) patients died during  
the period consisting of 72 males and 71 females (Table  
3
). The mean duration of stay in the unit prior to death  
The major causes of admission were malaria (44.4%),  
was 17 hours while their mean age was 38 months; with  
over 80% being five years or less (Table 3). Seventy-one  
(49.6%) deaths occurred in the first year of life; al-  
though a peak mortality of 31.5% occurred among chil-  
dren aged two to five years (Table 3).  
respiratory tract infections  
(17.8%) and gastroenteri-  
tis with moderate or severe dehydration (10.1%). They  
accounted for 72.3% of the admissions (Table 1). Most  
(
69.1%) of the cases of respiratory tract infections were  
bronchopneumonia. 'Miscellaneous' in table 1 include  
malignancies (acute lymphoblastic leukaemia, hodgkin's  
lymphoma), excessive bleeding in haemophiliac secon-  
dary to tongue laceration and post-circumcision, surgical  
7
3
Table 3: Age and Sex Distribution among 143 Deaths  
African 6countries such17 as Ghan1a8, Kenya, Tanzania19,  
1
Zambia, Sierra Leone, Ethiopia and Mozambique.  
Age  
No. of  
M
F
% of  
1
6-19  
also confirm bacterial infections like  
Their reports  
Patients  
Total  
pneumonia, gastroenteritis and meningitis as major  
causes of childhood morbidity and mortality. This is  
similar to findings from a study conducted at the paedi-  
atric emergency department of a tertiary care teaching  
and referral hospital in Kabul, Afghanistan to assess the  
morbidity and mortality pattern of illness in paediatric  
population where the most comm20on illnesses were diar-  
rhoea and respiratory infections.  
1
7
2
>
Total  
-6 months  
-12 months  
-5 years  
29  
42  
45  
27  
15  
26  
21  
10  
72  
14 20.3  
16 29.3  
24 31.5  
17 18.9  
71 100.0  
5 years  
143  
Severe malaria accounted for the largest number of  
deaths (29.4%) in the unit, followed by meningitis  
The mortality rate of 2.8% from gastroenteritis in the  
present study is close to the one of 2.6% reported by  
(
16.9%) and septicaemia (15.4%) (Table 4). Thus, over  
0% of the deaths were caused by infectious diseases.  
4
8
Diakparome from the sam1e centre over three decades  
2
ago and by Ransome-kuti in Lagos almost four dec-  
Table 4: Major Causes of Mortality in Admitted Pa-  
ades ago. We seem not to have improved over the years.  
tients  
Measles with its complications was one of the major  
paediatric emergencies in the earlier report from Benin  
City. However, this was not prominent in the present  
Condition  
No. of  
Deaths  
%
Mortality  
% of Total  
Admissions  
4
Severe malaria  
Meningitis  
Septicaemia  
Paediatric AIDS  
RTIs  
Hb-SS Disease  
Gastroenteritis  
Accidental poisoning  
Miscellaneous  
Total  
42  
24  
22  
12  
11  
7
4
2
19  
143  
29.4  
16.9  
15.4  
8.4  
7.7  
4.9  
2.8  
1.4  
13.3  
100.0  
1.29  
0.74  
0.67  
0.37  
0.34  
0.21  
0.12  
0.06  
0.58  
4.39  
study as there were fewer cases of measles and when  
they presented they were usually admitted directly into  
the side-rooms of the main paediatric wards for barrier  
nursing while those requiring emergency care were first  
managed in CHER before transfer to the main wards.  
These few cases were in the miscellaneous group.2This  
1
is similar to documentations from other Nigerian and  
1
6,19  
Measles occurrence may have de-  
African studies.  
clined because of the effects of the National Programme  
on Immunization (NPI).  
AIDS : Acquired Immune Deficiency Syndrome  
RTIs : Respiratory tract infections  
Hb-SS Disease : Haemoglobin-SS Disease  
The low number of measles morbidity and mortality is a  
success story, but high immunization coverage rates  
must be sustained.  
Severe malnutrition was also not prominent in the cur-  
rent study unlike in the previous study conducted in our  
centre where it constituted 2.1% of the total emergency  
admissions. Probably the effect of health education is  
paying out. It is important to note, however that paediat-  
ric AIDS did not feature in the earlier Benin series4 as  
was the case in the present study. The onset of the Hu-  
man Immuno2d2eficiency Virus (HIV) epidemic in West  
Africa began in 1985 but was first diagnosed in Nige-  
Discussion  
The current study revealed that infectious diseases are  
the major causes of morbidity and mortality in CHER,  
UBTH, Benin City. This is in consonance with the find-  
8
-12  
ings from various other studies over the past decades.  
Malaria, respiratory tract infections and gastroenteritis  
which were the major causes of admission are recog-  
nized by the World Health Organisation as the major  
causes of under-five morbidity and mortality either as a  
23  
ria in 1986. HIV/AIDS infection in children has modi-  
fied the morbidity and mortality pattern among them. It  
has also affected childhood immunization and nutrition  
of infants. It is an important cause of morbidity and  
death in children in developing countries like ours and  
action needs to be taken against this growing threat.  
1
3,14  
single entity or in combination with other causes.  
Fortunately, the core programme of integrated manage-  
ment 1o5f childhood illnesses (IMCI) targets these dis-  
eases.  
The overall mortality of 4.4% in the current study as  
opposed to 10% mortality in the earlier Benin study is a  
great improvement. Despite inadequate facilities, over  
Majority of the deaths in this series occurred among  
und8e,1r0--f1i2ves as was also documented by previous stud-  
4
ies,  
thus indicating their vulnerability and the need  
9
5% of our admitted patients were salvaged.  
to pay special attention to this group of children if an  
overall reduction in child mortality rate is to be  
achieved.  
Some patients remained in the unit for as long as six  
days either because they required acute emergency care  
for the period or for logistic reasons in which case there  
may be no bed space at the main paediatric wards to  
enable their transfer.  
The leading role of malaria as a cause of childhood hos-  
pitalisation and mortality in this series h1a0-s12also been  
documented by other authors from Nigeria  
and other  
7
4
Conclusion  
be used to guide public-health policies and programmes.  
Also, a boost in the coverage of our health insurance  
scheme would be a step in the right direction.  
Infectious diseases are still the major causes of morbid-  
ity and mortality especially in under-fives in our local-  
ity. Achievement of the millennium development goal of  
reducing child mortality by two-thirds from the 1990  
rate will depend on renewed efforts to prevent and con-  
trol malaria, acute respiratory infections and diarrhoea in  
the Africa region. The role of environmental sanitation,  
health education and good nutrition in the health of the  
child must be brought to the fore. Vaccination against  
infectious organisms like Haemophilus influenzae and  
Streptococcus pneumoniae which are major causes of  
pneumonia and meningitis in childhood should be intro-  
duced into the nation's immunization schedule as part of  
the NPI. The reports of the causes of child morbidity  
and deaths should  
Conflict of interest: none  
Funding: none  
Acknowledgement  
We acknowledge the assistance of doctors and medical  
students in the Paediatric Emergency Unit of the Depart-  
ment of Child Health, UBTH, in data collation. We are  
also grateful to the record officers of the unit for their  
assistance in retrieving the relevant records.  
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