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Pattern of admissions to the paediatric medical wards (1995 to 1996) at Harare Hospital, Zimbabwe
K J Nathoo1, C H Bannerman, D J Pirie
1Department of Paediatrics and Child Health, University of Zimbabwe Medical School, Avondale, Harare.
Objective:
To document the pattern of disease and outcome of medical paediatric admissions at Harare hospital.
Design:
Cross sectional study from 1 June 1995 to 30th May 1996.
Setting:
Medical paediatric wards, Harare Central Hospital.
Subjects:
All admissions below the age of nine years.
Main Outcome Measures:
Socio-demographic features, nutritional status, clinical diagnoses, duration of hospital stay and mortality.
Results:
A total of 8,826(90.0%) of the admissions were assessed. The majority(51.8%) of the patients were one year and below. "Road to Health" cards, available for 94.4% children, showed 88.0% had appropriate immunizations for age. Forty nine percent had lower respiratory tract infection either as only, or concurrent with other diagnoses, with an overall fatality rate of 16.2%. Acute diarrhoea was the second most frequent condition (21.0%) with an associated case fatality rate of 11.3%. Mortality rates for neonatal sepsis and bacterial meningitis were 12.3% and 32.8% respectively. Severe malnutrition defined as less than 60% of the expected weight for age, was present in 12.5% with an associated fatality rate of 28.7%. Based on clinical suspicion 23.2% of the total children were tested for HIV antibodies and 82.0% were positive. Overall case fatality among the inpatients was 17.8% and 36.7% of the total deaths occurred within 24 hours of admission.
Conclusion:
There is a need to re-evaluate our management strategies for common conditions including those with HIV infection. Standardization of case management is an important and essential step towards reduction in mortality both at the primary and referral health institutions.