Mortality within 24 hours of admission to the Paediatric Unit, Harare Central Hospital, Zimbabwe

Area of Science:

• Paediatric critical care
• Epidemiology of childhood mortality
• Respiratory illness in children

Background:

• Deaths within 24 hours of admission contribute significantly to overall paediatric mortality.
• Understanding risk factors for early mortality is crucial for improving outcomes in paediatric hospitals.
• Harare Central Hospital's Paediatric Unit serves a population where early childhood mortality is a concern.

Purpose of the Study:

• To determine the proportion of deaths occurring within 24 hours of paediatric hospital admission.
• To characterize children who die within 24 hours of admission.
• To identify risk factors associated with mortality within 24 hours of admission in a paediatric hospital.

Main Methods:

• A prospective cohort study was conducted in the Paediatric Unit of Harare Central Hospital.
• 737 paediatric admissions were enrolled, with data collected on pre-admission factors, clinical signs, and diagnoses.
• The primary outcome measure was death within 24 hours of admission.

Main Results:

• The case fatality rate within 24 hours of admission was 7.3% (54/737), accounting for 34.6% of total deaths.
• Subcostal recessions on admission, a marker for severe pneumonia, were significantly associated with a 29.9-fold increased risk of mortality within 24 hours.
• Socio-demographic factors, illness duration, fever, admission diagnosis, and A&E delays were not significantly associated with early mortality.

Conclusions:

• The rate of deaths within 24 hours of paediatric admission remains unacceptably high.
• Subcostal recessions are a critical indicator of severe pneumonia and a major risk factor for early mortality.
• Early identification and aggressive management of childhood pneumonia are essential to reduce in-hospital mortality.