1921
Volume 101, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

In low-resource settings, many children are severely ill at arrival to hospital. The risk factors for mortality among such ill children are not well-known. Understanding which of these patients are at the highest risk could assist in the allocation of limited resources to where they are most needed. A cohort study of severely ill children treated in the resuscitation room of the pediatric emergency department at Queen Elizabeth Central Hospital in Malawi was conducted over a 6-month period in 2017. Data on signs and symptoms, vital signs, blood glucose levels, and nutritional status were collected and linked with in-hospital mortality data. The factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Data for 1,359 patients were analyzed and 118 (8.7%) patients died. The following factors were associated with mortality: presence of any severely deranged vital sign, unadjusted odds ratio (UOR) 2.6 (95% CI 1.7–4.0) and adjusted odds ratio (AOR) 3.2 (95% CI 2.0–5.0); severe dehydration, UOR 2.6 (1.4–5.1) and AOR 2.8 (1.3–6.0); hypoglycemia glycemia (< 5 mmol/L), UOR 3.6 (2.2–5.8) and AOR 2.7 (1.6–4.7); and severe acute malnutrition, UOR 5.8 (3.5–9.6) and AOR 5.7 (3.3–10.0). This study suggests that among severely sick children, increased attention should be given to those with hypo/low glycemia, deranged vital signs, malnutrition, and severe dehydration to avert mortality among these high-risk patients.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. World Health Organization, 2017. Child Mortality Report World Health Organisation. Geneva, Switzerland: WHO. [Google Scholar]
  2. UNICEF, 2018. Every Child Alive: The Urgent Need to End New Born Death Levels. New York: UNICEF. Available at: https://www.unicef.org/publications/files/Every_Child_Alive_The_urgent_need_to_end_newborn_deaths.pdf. [Google Scholar]
  3. Adeboye MA, Ojuawo A, Ernest SK, Fadeyi A, Salisu OT, , 2010. Mortality pattern within twenty-four hours of emergency paediatric admission in a resource-poor nation health facility. West Afr J Med 29: 249252. [Google Scholar]
  4. World Health Organization, 2005. Emergency Triage Assesment and Treatment (ETAT): Manual for Participants. Geneva, Swirtzerland: WHO. [Google Scholar]
  5. Molyneux E, Ahmad S, Robertson A, , 2006. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting. Bull World Health Organ 84: 314319. [Google Scholar]
  6. Pollack MM, Ruttimann UE, Getson PR, , 1988. Pediatric risk of mortality (PRISM) score. Crit Care Med 16: 11101116. [Google Scholar]
  7. Shann F, Pearson G, Slater A, Wilkinson K, , 1997. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 23: 201207. [Google Scholar]
  8. Parshuram CS, Hutchison J, Middaugh K, , 2009. Development and initial validation of the bedside paediatric early warning system score. Crit Care 13: R135. [Google Scholar]
  9. Brown SR, Martinez Garcia D, Agulnik A, , 2019. Scoping review of pediatric early warning systems (PEWS) in resource-limited and humanitarian settings. Front Pediatr 6: 410. [Google Scholar]
  10. Gordon DM, Shehibo A, Tazebew A, Huddart MR, Kadir A, Allen N, Draper H, Kokeb M, , 2014. Implementation of an in-patient pediatric mortality reduction intervention, Gondar University Hospital, Ethiopia. Public Health Action 4: 265270. [Google Scholar]
  11. Ronan A, Azad AK, Rahman O, Phillips RE, Bennish ML, , 1997. Hyperglycemia during childhood diarrhea. J Pediatr 130: 4551. [Google Scholar]
  12. Queen Elizabeth Central Hospital, Paediatric and Child Health Department, 2016. Paediatric White Book: Electronic Protocols for the Management of Common Childhood Illness in Malawi, 3rd edition. Blantyre, Malawi: Paediatric and Child Health Department, The College of Medicine, Queen Elizabeth Central Hospital, 13. [Google Scholar]
  13. World Health Organization, 2014. Intergrated Management of Childhood Illness: Chart Booklet. Geneva, Switzerland: WHO. [Google Scholar]
  14. Westergren H, Ferm M, Häggström P, , 2014. First evaluation of the paediatric version of the Swedish rapid emergency triage and treatment system shows good reliability. Acta Paediatr 103: 305308. [Google Scholar]
  15. World Health Organization, 2016. Guideline: Updates on Paediatric Emergency Triage, Assessment and Treatment: Care of Critically-Ill Children. Geneva, Switzerland: WHO. Available at: https://www.ncbi.nlm.nih.gov/books/NBK350528/. Accessed August 10, 2018. [Google Scholar]
  16. Willcox ML, Forster M, Dicko MI, Graz B, Mayon-White R, Barennes H, , 2010. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycaemia’? Trop Med Int Health 15: 232240. [Google Scholar]
  17. Nadjm B, Mtove G, Amos B, Hildenwall H, Najjuka A, Mtei F, Todd J, Reyburn H, , 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232237. [Google Scholar]
  18. Hosmer DW, Lemeshow S, , 2013. Applied Logistic Regression. Hoboken, NJ: John Wiley & Sons. [Google Scholar]
  19. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR, , 1996. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49: 13731379. [Google Scholar]
  20. Ljunggren M, Castrén M, Nordberg M, Kurland L, , 2016. The association between vital signs and mortality in a retrospective cohort study of an unselected emergency department population. Scand J Trauma Resus Emerg Med 24: 21. [Google Scholar]
  21. Baker T, Blixt J, Lugazia E, Schell CO, Mulungu M, Milton A, Castegren M, Eriksen J, Konrad D, , 2015. Single deranged physiologic parameters are associated with mortality in a low-income country. Crit Care Med 43: 21712179. [Google Scholar]
  22. Olson D, Davis NL, Milazi R, Lufesi N, Miller WC, Preidis GA, Hosseinipour MC, McCollum ED, , 2013. Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource-constrained hospitals in developing countries. Trop Med Int Health 18: 871878. [Google Scholar]
  23. Henning B, Lydersen S, Døllner H, , 2016. A reliability study of the rapid emergency triage and treatment system for children. Scand J Trauma Resus Emerg Med 24: 19. [Google Scholar]
  24. Gold DL, Mihalov LK, Cohen DM, , 2014. Evaluating the pediatric early warning score (PEWS) system for admitted patients in the pediatric emergency department. Acad Emerg Med 21: 12491256. [Google Scholar]
  25. Lighthall GK, Markar S, Hsiung R, , 2009. Abnormal vital signs are associated with an increased risk for critical events in US veteran inpatients. Resuscitation 80: 12641269. [Google Scholar]
  26. Churpek MM, Yuen TC, Edelson DP, , 2013. Predicting clinical deterioration in the hospital: the impact of outcome selection. Resuscitation 84: 564568. [Google Scholar]
  27. Churpek MM, Yuen TC, Huber MT, Park SY, Hall JB, Edelson DP, , 2012. Predicting cardiac arrest on the wards: a nested case-control study. Chest 141: 11701176. [Google Scholar]
  28. Prytherch DR, Smith GB, Schmidt PE, Featherstone PI, , 2010. ViEWS—towards a national early warning score for detecting adult inpatient deterioration. Resuscitation 81: 932937. [Google Scholar]
  29. Paintal K, Aguayo VM, , 2016. Feeding practices for infants and young children during and after common illness. Evidence from South Asia. Matern Child Nutr 12: 3971. [Google Scholar]
  30. Uleanya ND, Aniwada EC, Nwokoye IC, Ndu IK, Eke CB, , 2017. Relationship between glycemic levels and treatment outcome among critically ill children admitted into emergency room in Enugu. BMC Pediatr 17: 126. [Google Scholar]
  31. Achoki R, Opiyo N, English M, , 2010. Mini-review: management of hypoglycaemia in children aged 0–59 months. J Trop Pediatr 56: 227234. [Google Scholar]
  32. Barennes H, Sayavong E, Pussard E, , 2016. High mortality risk in hypoglycemic and dysglycemic children admitted at a referral hospital in a non malaria tropical setting of a low income country. PLoS One 11: e0150076. [Google Scholar]
  33. World Health Organization, 2013. Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources. Geneva, Switzerland: WHO. [Google Scholar]
  34. Baker T, Dube Q, Langton J, Hildenwall H, , 2018. Mortality impact of an increased blood glucose cut-off level for hypoglycaemia treatment in severely sick children in Malawi (SugarFACT trial): study protocol for a randomised controlled trial. Trials 19: 33. [Google Scholar]
  35. Barus ST, Rani R, Lubis NU, Hamid ED, Tarigan S, , 1990. Clinical features of severe malnutrition at the pediatric ward of Dr. Pirngadi Hospital Medan. Paediatr Indones 30: 286292. [Google Scholar]
  36. Chiabi A, Malangue B, Nguefack S, Dongmo FN, Fru F, Takou V, Angwafo F, 3rd, 2017. The clinical spectrum of severe acute malnutrition in children in Cameroon: a hospital-based study in Yaounde, Cameroon. Transl Pediatr 6: 3239. [Google Scholar]
  37. Pelletier DL, Frongillo JEA, Schroeder DG, Habicht J-P, , 1994. A methodology for estimating the contribution of malnutrition to child mortality in developing countries. J Nutr 124(Suppl 10): 2106S2122S. [Google Scholar]
  38. Schroeder DG, Brown KH, , 1994. Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact. Bull World Health Organ 72: 569579. [Google Scholar]
  39. Fawzi WW, Herrera MG, Spiegelman DL, el Amin A, Nestel P, Mohamed KA, , 1997. A prospective study of malnutrition in relation to child mortality in the Sudan. Am J Clin Nutr 65: 10621069. [Google Scholar]
  40. Zachariah R, Spielmann MP, Harries AD, Salaniponi FML, , 2002. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg 96: 291294. [Google Scholar]
  41. Maitland K, 2011. Mortality after fluid bolus in African children with severe infection. New Engl J Med 364: 24832495. [Google Scholar]
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  • Received : 09 Feb 2019
  • Accepted : 29 Apr 2019
  • Published online : 08 Jul 2019

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