Characteristics of and Risk Factors for Early Pediatric Mortality at Zomba Central Hospital, Malawi

Background: Pediatric mortality rates are high throughout sub-Saharan Africa with most deaths occurring within 48 hours of admission to hospital. Early identification and treatment of at risk children is essential to improve outcomes, however, few studies have identified disease specific risk factors for early mortality.
Study Aims: To identify risk factors for early pediatric mortality and to explore areas for improvement in diagnostic and treatment practices.
Study Design: Case-control study of patients admitted to the pediatrics ward of Zomba Central Hospital, Malawi.
Methodology: Cases included all pediatric deaths over a four-month period in 2010 occurring within 48 hours of admission with a diagnosis among the four most common causes of death (malaria, pneumonia, diarrhea/dehydration, meningitis or measles given a large outbreak during the study period). Controls included children admitted during the same period, with a discharge diagnosis among the same 5 diagnoses, who survived to at least 72 hours.
Analysis: Associations between mortality and clinical characteristics were assessed using STATA 11.0.
Results: Overall, 142 cases and 162 controls were included. 62.7% of deaths occurred within 12 hours with malaria the most common diagnosis in both groups. Clinical characteristics on presentation associated with death included: symptoms/signs of respiratory distress (OR1.9, 95% CI 1.0-3.4, p=0.04), low Blantyre Coma Score (OR 3.4, 95% CI 2.1-5.6, p<0.01), age under 5 (OR 3.2, 95% CI 1.1-9.3, p=0.03) and pallor among malaria cases (OR2.2, 95% CI 1.8-6.6), p<0.01). Areas identified for quality improvement included delay in initial investigations and initiation of treatment both prior to transfer to and after admission to the district hospital.
Conclusion: Improvements in the identification of children at risk for early mortality are critical to reducing mortality through early intervention.