Epidemiology of Disease and Mortality From a PICU in Mozambique
Maria Punchak1, Kaitlin Hall1, Amir Seni2
1David Geffen School of Medicine at UCLA, Los Angeles, CA.
Insights
Pediatric critical care in Mozambique reveals high mortality rates, with sepsis and infectious diseases being leading causes. This data informs targeted quality improvement projects for better patient outcomes in low-income settings.
Area of Science:
- Pediatric critical care epidemiology
- Global health disparities in healthcare access
- Tertiary care outcomes in low-income countries
Background:
- Pediatric critical care delivery is severely limited in low-income countries due to resource and provider shortages.
- Limited studies exist on the epidemiology of diseases managed in pediatric intensive care units (PICUs) within low-income nations.
- Understanding disease patterns and outcomes is crucial for developing targeted interventions.
Purpose of the Study:
- To document primary diagnoses and mortality rates of patients in a Mozambican tertiary PICU.
- To identify key disease burdens and risk factors for mortality.
- To inform the development of quality improvement projects through international academic collaboration.
Main Methods:
- Retrospective, observational study design.
- Analysis of all available patient data from January 2013 to December 2013 at Hospital Central de Maputo, Mozambique.
- Inclusion of all patients admitted to the tertiary academic PICU.
Main Results:
- The most common diagnoses were malaria (22%), sepsis (18%), and respiratory tract infections (12%).
- Overall PICU mortality rate was 25%, with sepsis (59%) and encephalopathy (56%) showing the highest mortality.
- Median PICU length of stay was 2 days; burns patients had the longest stay (4 days).
Conclusions:
- Infectious diseases and trauma are prevalent in this Mozambican PICU, with high overall mortality compared to high-income countries.
- Findings provide essential data for creating targeted, collaborative quality improvement initiatives in Mozambique.
- Further research is recommended to evaluate the impact of implemented interventions.
Objectives:
Delivery of pediatric critical care in low-income countries is limited by a lack of infrastructure, resources, and providers. Few studies have analyzed the epidemiology of disease associated with a PICU in a low-income country. The aim of this study was to document the primary diagnoses and the associated mortality rates of patients presenting to a tertiary PICU in Mozambique in order to formulate quality improvement projects through an international academic partnership. We hypothesized that the PICU mortality rate would be high and that sepsis would be a common cause of death.
Design:
Retrospective, observational study.
Setting:
Tertiary academic PICU.
Patients:
All admitted PICU patients.
Interventions:
All available data collection forms containing demographic and clinical data of patients admitted to the PICU at Hospital Central de Maputo, Mozambique from January 2013 to December 2013 were analyzed retrospectively.
Measurements And Main Results:
The patient median age was 2 years (57% male). The most common primary diagnoses were malaria (22%), sepsis (18%), respiratory tract infections (12%), and trauma (6%). The mortality rate was 25%. Mortality rates were highest among patients with sepsis (59%), encephalopathy (56%), noninfectious CNS pathologies (33%), neoplastic diseases (33%), meningitis/encephalitis (29%), burns (26%), and cardiovascular pathologies (26%). The median length of PICU stay was 2 days. HIV exposure/infection had a nonstatistically significant association with mortality. Patients admitted for burns had the highest median length of PICU stay (4 d). Most trauma admissions were male (75%), and approximately half of all trauma admissions had an associated head injury (55%).
Conclusions:
Infectious disease and trauma were highly represented in this Mozambican PICU, and overall mortality was high compared with high-income countries. With this knowledge, targeted collaborative projects in Mozambique can now be created and modified. Further research is needed to monitor the potential benefits of such interventions.
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