|
Indian Pediatr 2017;54: 60-61 |
|
Causes of
Death among Children Aged >5 Years in a Public Hospital in New
Delhi
|
* Manas Pratim Roy, Ratan Gupta, Meenakshi Bhatt and
Kailash Chander Aggarwal
Department of Pediatrics, VMMC and Safdarjung Hospital,
New Delhi, India.
Email: [email protected]
Published online:
November 05, 2016. PII:S097475591600029
|
Retrospective analysis was done
for 3817 children aged 5-12 years admitted in a tertiary-care, public
hospital in New Delhi between January to December, 2015. Mortality rate
was 5.8%. About 47.1% deaths were due to central nervous system
involvement; viral meningoencephalitis being the predominant cause.
Overall, infectious diseases caused >80% of deaths. Public health
interventions to reduce child mortality need to review such data for
effective measures.
Keywords: Mortality, Outcome, Inpatient.
|
A bout eight million deaths took
place every year
among children aged between 5-12 years, with
93.7% of such deaths limited to low- and
middle-income countries [1]. Not much information is available about the
causes of deaths in this age-group in hospitalized patients [2]. The
present study reviews the mortality of all children aged 5 to 12 years,
admitted in a tertiary-care public hospital in New Delhi, between
January to December, 2015.
Hospital records were retrieved and analyzed; and the
data of surgical cases were excluded. Those who were discharged against
medical advice or absconded were also excluded. All the diagnoses were
coded by two physicians individually. Depending on the diagnosis, deaths
were attributed to a particular system. In case of disagreement, an
expert opinion was sought.
Out of 3817 admissions in this age-group, overall
mortality rate was 5.8% (221, 57.9% males). It was 6.7%, after excluding
504 children who were discharged against medical advice or absconded.
Mean age was 8.59 years. Most of the children (42.5%) died within 24
hours of admission. The mortality rate was slightly higher in females
(5.7% against 5.5% in males). Overall, 34% and 43% deaths occurred in
age group 5-7 years and 8-10 years, respectively.
About 47.1% deaths could be ascribed to central
nervous system (CNS) causes. Overall, viral meningoencephalitis was the
most common cause of mortality (27%) followed by tubercular meningitis
(9%), sepsis (7.2%) and pneumonia (5.9%). Acute lymphoblastic leukemia
was the most common haematological abnormality, contributing to 4.5% of
the deaths. Overall, infection was implicated in 83.3% deaths.
A higher death rate is always expected in a
tertiary-centre as many complicated and critical cases get referred from
different district- and state-level hospitals. More than 42% deaths
within 24 hours of admission indicate referral of very sick children.
Similar to previous studies, majority of the deaths were attributed to
CNS pathology [3,4]; though, it could be due to referral bias, as
complicated neurological cases are usually referred to tertiary- care
hospitals. Globally, infectious diseases remain as first priority for
pediatric health, causing 68% deaths among under-five children [5]. Our
findings demonstrated the same trend among the older children. In view
of the large number of cases of meningoencephalitis contributing to
mortality, there is need to provide facility for investigating/ treating
meningitis/ encephalitis at the district level to reduce loss of time in
referral to tertiary hospitals. Limited resources are to be allotted
optimally in public hospitals to ensure care at both the levels. Amidst
the paucity of epidemiological documents in this age group, this article
attempts to clarify the various causes of mortality in Pediatric
patients older than five years. Future prospective studies should
explore etiology and changing trend in referral pattern so that
appropriate public health interventions can be planned.
References
1. Jamison DT, Shahid-Salles SA, Jamison J, Lawn
JE, Zupan J. Incorporating Deaths Near the Time of Birth into
Estimates of the Global Burden of Disease. In: Lopez AD,
Mathers CD, Ezzati M, Jamison DT, Murray C, eds. Global Burden of
Disease and Risk Factors. New York: Oxford University Press, 2006.
2. Morris SK, Bassani DG, Awasthi S, Kumar R,
Shet A, Suraweera W, et al. Diarrhea, pneumonia, and
infectious disease mortality in children aged 5 to 14 years in
India. PLoS ONE. 2011;6:e20119.
3. Roy RN, Nandy S, Shrivastava P, Chakraborty A,
Dasgupta M, Kundu TK. Mortality pattern of hospitalized children in
a tertiary care hospital of Kolkata. Indian J Community Med.
2008;33:187-9.
4. Patil SW, Godale LB. Mortality pattern of
hospitalized children in a tertiary care hospital in Latur: a record
based retrospective analysis. Natl J Community Med. 2013;4:96-9.
5. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG,
et al. Global, regional and national causes of child mortality,
2008: a systematic analysis. Lancet. 2010;375:1969-87.
|
|
|
|