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Observations from Mortality Trends at The Children's Hospital, Accra, 2003-2013
Edem M A Tette1,2, Margaret L Neizer1, Mame Yaa Nyarko1
1Princess Marie Louis Children's Hospital (PML), Accra, Ghana.
Insights
Child mortality at Princess Marie Louise Children's Hospital (PML) significantly decreased, especially in under-fives, following various interventions. However, mortality in older children remains a concern, necessitating targeted strategies and regular data collection for continuous improvement.
Area of Science:
- Pediatric Medicine
- Public Health
- Epidemiology
Background:
- Facility-based studies are crucial for evaluating interventions to reduce child mortality, offering insights beyond national data.
- Princess Marie Louise Children's Hospital (PML) data provides a unique opportunity to assess child mortality trends and the impact of interventions.
- Millennium Development Goal 4 (MDG 4) aimed to reduce child mortality, making hospital-based assessments vital for progress tracking.
Purpose of the Study:
- To examine child mortality trends at PML from 2003 to 2013.
- To correlate observed mortality trends with hospital-based and community interventions.
- To assess the effectiveness of interventions in achieving reductions in child mortality, particularly in relation to MDG 4.
Main Methods:
- A cross-sectional study analyzing patient death data over an 11-year period (2003–2013).
- Collected data on total annual admissions and significant hospital and population-based interventions during the study period.
- Calculated annual changes in mortality rates for overall, under-five, and older child populations.
Main Results:
- Total admissions tripled, while overall mortality saw an average annual decrease of -7.12%.
- Under-five mortality decreased significantly (-7.38% annually), with most reductions occurring between 2003–2006, followed by a temporary increase and then a slow decline.
- Malaria mortality declined, mirroring continental trends, potentially influenced by policy changes, improved malnutrition treatment, and increased pediatric input.
Conclusions:
- Under-five mortality at PML has substantially declined, but mortality in older children requires focused attention and intervention.
- Regular, planned data collection for hospital mortality reviews is essential for evaluating intervention effectiveness and understanding contextual factors.
- Systematic mortality reviews provide benchmarks, identify care shortfalls, and ensure sustained improvements in child survival.
Objective:
Facility-based studies provide an unparalleled opportunity to assess interventions deployed in hospitals to reduce child mortality which is not easily captured in the national data. We examined mortality trends at the Princess Marie Louise Children's Hospital (PML) and related it to interventions deployed in the hospital and community to reduce child mortality and achieve the Millennium Development Goal 4 (MDG 4).
Methods:
The study was a cross-sectional review of data on consecutive patients who died at the hospital over a period of 11 years, between 2003 and 2013. The total admissions for each year, the major hospital-based and population-based interventions, which took place within the period, were also obtained.
Results:
Out of a total of 37,012 admissions, 1,314 (3.6%) deaths occurred and admissions tripled during the period. The average annual change in mortality was -7.12% overall, -7.38% in under-fives, and -1.47% in children ≥5 years. The majority of the deaths, 1,187 (90.3%), occurred in under-fives. The observed decrease in under-five (and overall) mortality rate occurred in a specific and peculiar pattern. Most of the decrease occurred during the period between 2003 and 2006. After that there was a noticeable increase from 2006 to 2008. Then, the rate slowly decreased until the end of the study period in 2013. There was a concomitant decline in malaria mortality following a pattern similar to the decline observed in other parts of the continent during this period. Several interventions might have contributed to the reduction in mortality including the change in malaria treatment policy, improved treatment of malnutrition and increasing paediatric input.
Conclusion:
Under-fives mortality at PML has declined considerably; however, the reduction in mortality in older children has been minimal and thus requires special attention. Data collection for mortality reviews should be planned and commissioned regularly in hospitals to assess the effects of interventions and understand the context in which they occur. This will provide benchmarks and an impetus for improving care, identify shortfalls and ensure that the gains in child survival are maintained.
