Background:In sub-Saharan Africa, one in 13 children died before their fifth
birthday. Objective: To study mortality among children hospitalized in
the intensive care unit of the CHUPB. Methodology: This was a
retrospective, descriptive study over a 12-month period. Included were children
aged 1 month to 15 years hospitalized in the intensive care unit and who died
during the period. The data were entered and analyzed through the Epi Info
software. The statistical test used was Pearson’s chi2. Results: The
overall mortality rate was 21.49%. The sex ratio was 1.14 and the mean age was
3.17 ± 2.21 years. Children <5 years
of age accounted for 78.49% (n = 197) of cases. Deaths were more frequent in
January, April and December. The mean time to
consultation was 6.91 ± 1.8 days. Fever 78.48% (n = 197), diarrhea/vomiting
35.45% (n = 89) and convulsions 26.29% (n = 66) were the main reasons for
consultation. Prior to admission, treatment was administered in 73.38% (n =
184) of children. The main diagnoses of death were: septic shock 29.08% (n =
73), hypovolemic shock post AEG 17.13% (n = 43), severe malaria 10.76% (n = 27)
and meningitis 6.38% (n = 16). Death was early in 66.53% (n = 167) of cases. It
was influenced by male sex, origin of residence, rural residence, herbal
medicine and the occurrence of deaths during the shifts after 16 hours. Conclusion: Mortality in pediatrics remains a concern in our practice. It is related to
conditions that are mostly preventable by vaccination, information, education
and communication.
References
[1]
Bitwe, R., Dramaix, M. and Hennart, P. (2006) Modèle pronostique simplifié d’évaluation de la mortalité intra hospitalière globale des enfants en Afrique centrale. Tropical Médecine International Health, 11, 73-80.
https://doi.org/10.1111/j.1365-3156.2005.01540.x
[2]
OMS (2020) Enfants: Améliorer leur survie et leur bien-être.
https://www.who.int/fr/news-room/fact-sheets/detail/children-reducing-mortality
[3]
Bah, A., Bagayoko, T.B., Kassogué, A., Dramé, B.M., Haber, B., Thiéro, A., et al. (2021) Morbidité et mortalité des enfants au service de pédiatrie de l’hôpital Nianankoro Fomba de Ségou. Mali Sante Publique, 11, 81-83.
https://doi.org/10.53318/msp.v11i1.1898
[4]
Young, M.P. and Birkmeyer, J.D. (2000) Potential Reduction in Mortality Rates Using an Intensivist Model to Manage Intensive Care Units. Effective Clinical Practice, 3, 284-289.
[5]
Rapport des Nations Unies (2015) Statistiques mondiales, taux de mortalité infantile, Objectifs du Millénaire pour le développement.
[6]
La santé en Afrique, un continent, deux mondes (2003) World Population Data Sheet, Population Reference Bureau, Washington, Etats-Unis.
https://www.persee.fr/doc/bagf_0004-5322_2010_num_87_1_8184
[7]
Rapport OMD (2012) évaluation des progrès accomplis en Afrique dans la réalisation des objectifs du Millénaire pour le développement.
https://www.undp.org/sites/g/files/zskgke326/files/publications/MDG%20Report%202012_FRE.pdf
[8]
Bryce, J., Boschi-Pinto, C., Shibuya, K. and Black, R.E. (2005) WHO Estimates of the Causes of Death in Children. The Lancet, 365, 1147-1152.
https://doi.org/10.1016/S0140-6736(05)71877-8
[9]
Ramesh, S. (2003) Paediatric Intensive Care—Update. Indian Journal of Anaesthesia, 47, 338-344.
[10]
Abhulimhen-Iyoha, B.I., Kumar, P.S. and Kishore, K.V.N. (2014) Morbidity Pattern and Outcome of Patients Admitted into a Pediatric Intensive Care Unit in India. Indian Journal of Clinical Medicine, 5, 1-5. https://doi.org/10.4137/IJCM.S13902
[11]
Vinayak, K.P., Sandeep, R. and Jennifer, V.A. (2017) Comparison of Severity Scoring Systems in a Pediatric Intensive Care Unit in India: A Single Center Prospective, Observational Cohort Study. Journal of Pediatric Intensive Care, 6, 98-102.
[12]
Essola, L., Mpira, S., Minko, J., Soami, V., Ngomas, J.F. and Sima, Z.A. (2019) Morbidité et mortalité pédiatrique en unité de soins intensifs du centre Hospitalier de Libreville. Bulletin Médical d’Owendo, 17, 29-35.
[13]
El-Nawawy, A. (2003) Evaluation of the Outcome of Patients Admitted to the Pediatric Intensive Care Unit in Alexandria Using the Pediatric Risk Mortality (PRISM) Score. Journal of Tropical Pediatrics, 49, 109-114.
https://doi.org/10.1093/tropej/49.2.109
[14]
Embu, H.Y., Yiltok, S.J., Isamade, E.S., Nuhu, S.I., Oyeniran, O.O. and Uba, F.A. (2011) Paediatric Admissions and Outcome in a General Intensive Care Unit. African Journal of Paediatric Surgery, 8, 57-61.
[15]
McCrossan, L., Bickerstaffe, W., Mustafa, S.M. anderson, L., Cheater, L., Jayson, D., et al. (2007) Referrals to Intensive Care: A Region-Wide Audit. Critical Care, 11, Article No. 403. https://doi.org/10.1186/cc5134
[16]
Singhal, D., Kumar, N., Puliyel, J.M., Singh, S.K. and Srinivas, V. (2001) Prédiction de la mortalité par application du score PRISM en unité de soins intensifs. Pédiatre Indien, 38, 714-719.
[17]
Khilnani, P., Sarma, D., Singh, R., Uttam, R., Rajdev, S., Makkar, A. and Kaur, J. (2004) Demographic Profile and Outcome Analysis of a Tertiary Level Pediatric Intensive Care Unit. Indian Journal of Pediatrics, 71, 587-591.
https://doi.org/10.1007/BF02724117
[18]
Bellad, R., Rao, S., Patil, V.D. and Mahantshetti, N.S. (2009) Outcome of Intensive Care Unit Patients Using Pediatric Risk of Mortality (PRISM) Score. Indian Pediatrics, 46, 1091-1092.
[19]
Choi, K.M.S., Ng, D.K.K., Wong, S.F., Kwok, K., Chow, P., Chan, C. and Ho, J.C. (2005) Assessment of the Pediatric Index of Mortality (PIM) and the Pediatric Risk of Mortality (PRISM) III Score for Prediction of Mortality in a Paediatric Intensive Care Unit in Hong Kong. Hong Kong Medical Journal, 11, 97-103.
[20]
Tyagi, P., Tullu, M.S. and Agrawal, M. (2018) Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit. Journal of Pediatric Intensive Care, 7, 201-206. https://doi.org/10.1055/s-0038-1673671
[21]
Burns, J.P., Sellers, D.E., Meyer, E.C., Lewis-Newby, M. and Truog, R.D. (2014) Epidemiology of Death in the PICU at Five U.S. Teaching Hospitals. Pediatric Critical Care, 42, 2101-2108. https://doi.org/10.1097/CCM.0000000000000498
[22]
Pollack, M.M., Holubkov, R., Funai, T., Clark, A., Berger, J.T., Meert, K., Pollack, M.M., Holubkov, R., Funai, T., et al. (2014) Pediatric Intensive Care Outcomes: Development of New Morbidities during Pediatric Critical Care. Pediatric Critical Care Medicine, 15, 821-827. https://doi.org/10.1097/PCC.0000000000000250
[23]
Costa, G.A., Delgado, A.F., Ferraro, A. and Okay, T.S. (2010) Application of the Pediatric Risk of Mortality Score (PRISM) Score and Determination of Mortality Risk Factors in A Tertiary Pediatric Intensive Care Unit. Clinics (Sao Paulo), 65, 1087-1092. https://doi.org/10.1590/S1807-59322010001100005
[24]
Dursun, O., Hazar, V., Tezcan Karasu, G., Uygun, V., Ozgur, T. and Yesilipek, A. (2009) Prognostic Factors in Pediatric Cancer Patients Admitted to the Pediatric Intensive Care Unit. Journal of Pediatric Hematology/Oncology, 31, 481-484.
https://doi.org/10.1097/MPH.0b013e3181a330ef
[25]
Perin, J., Mulick, A., Yeung, D., Villavicencio, F., Lopez, G., Strong, K.L., et al. (2022) Global, Regional, and National Causes of Under-5 Mortality in 2000-19: An Updated Systematic Analysis with Implications for the Sustainable Development Goals. The Lancet Child & Adolescent Health, 6, 106-115.
https://doi.org/10.1016/S2352-4642(21)00311-4
[26]
ICASEES (2021) MICS6-RCA Enquête par grappes à indicateurs multiples 2018-2019, Rapport final des résultats de l’enquête. Bangui, République Centrafricaine. 99 p.
[27]
Organisation mondiale de la Santé. Situation sanitaire: Mortalité, Statistiques sanitaires mondiales 2013.
https://www.who.int/gho/publications/world_health_statistics/2013/fr/
[28]
El Halal, M.G., Barbieri, E. and Filho, R.M. (2012) Admission Source and Mortality in a Pediatric Intensive Care Unit. Indian Journal of Critical Care Medicine, 16, 81-86. https://doi.org/10.4103/0972-5229.99114
[29]
Doumbia, A.K., Togo, B., Togo, P., Traoré, F., Coulibaly, O., Dembélé, A., et al. (2016) Morbidité et mortalité chez les enfants de 01 à 59 mois hospitalises au service de pédiatrie générale du chu Gabriel toure de janvier à décembre 2013. Revue Malienne d’Infectiologie et de Microbiologie, 8, 54-62.
https://doi.org/10.53597/remim.v0i0.912
[30]
Seshia, S.S., Seshia, M.M.K. and Sachdeva, R.K. (2003) Coma in Childhood. Developmental Medicine & Child Neurology, 19, 614-628.
https://doi.org/10.1111/j.1469-8749.1977.tb07995.x
[31]
World Health Organisation (2015) World Malaria Report 2015. Geneva, 243 p.
[32]
Sépou Yanza, M.C.A., Bogning Mejiozem, B.O., Kango, C.S., Nazita, N.S., Kobalo, G.N., et al. (2019) Neuropaludisme de l’enfant au Complexe Pédiatrique de Bangui: Aspects épidémiologiques, cliniques, thérapeutiques et évolutifs. Annales de L’université de Bangui, 5, 45.
[33]
Bobossi, S.G., Gody, J.C., Fioboy, R., Elowa, J.B. and Manirakiza, A. (2015) Comparaison de l’efficacité de l’Artemether et de la Quinine dans le traitement du paludisme grave chez les enfants à Bangui (RCA). Bulletin de la Société de Pathologie Exotique, 108, 107-111. https://doi.org/10.1007/s13149-015-0428-3
[34]
Colpan, A., Akinci, E., et al. (2005) Evaluation of Risk Factors for Mortality in Intensive Care Units: A Prospective Study from a Referral Hospital in Turkey. American Journal of Infection Control, 33, 12-15.
https://doi.org/10.1016/j.ajic.2004.09.005
[35]
Abebe, T., Girmay, M., Michael, G. and Tesfaye, M. (2015) The Epidemiological Profile of Pediatric Patients Admitted to the General Intensive Care Unit in an Ethiopian University Hospital. International Journal of General Medicine, 8, 63-67.
https://doi.org/10.2147/IJGM.S76378
[36]
Abdelatif, R.G., Montaser, M.M., Mahmoud, R.A., Bakheet Mohamed, M.A., Masafumi, G., et al. (2020) Characterization and Outcome of Two Pediatric Intensive Care Units with Different Resources. Critical Care Research and Practice, 2020, Article ID: 5171790. https://doi.org/10.1155/2020/5171790
[37]
Gullberg, N., Kalzén, H., Luhr, O., Göthberg, S., Winsö, O., Markström, A., et al. (2008) Immediate and 5-Year Cumulative Outcome after Paediatric Intensive Care in Sweden. Acta Anaesthesiologica Scandinavica, 52, 1086-1095.
https://doi.org/10.1111/j.1399-6576.2008.01711.x
[38]
Ambuehl, J., Karrer, A., Meer, A., Riedel, T. and Schibler, A. (2007) Quality of Life of Survivors of Paediatric Intensive Care. Swiss Medical Weekly, 137, 312-316.
https://doi.org/10.4414/smw.2007.11469
[39]
Jones, S., Rantell, K., Stevens, K., Colwell, B., Ratcliffe, J.R., Holland, P., Rowan, K. and Parry, G.J. (2006) Outcome at 6 Months after Admission for Pediatric Intensive Care: A Report of a National Study of Pediatric Intensive Care Units in the United Kingdom. Pediatrics, 118, 2101-2108. https://doi.org/10.1542/peds.2006-1455
[40]
Namachivayam, P., Shann, F., Shekerdemian, L., Taylor, A., Sloten, I.V., Delzoppo, C., et al. (2010) Three Decades of Pediatric Intensive Care: Who Was Admitted, What Happened in Intensive Care, and What Happened Afterward, Pediatric. Critical Care Medicine, 11, 549-555.
https://doi.org/10.1097/PCC.0b013e3181ce7427
[41]
Klem, S.A., Pollack, M.M. and Getson, P.R. (1990) Cost, Resource Utilization, and Severity of Illness in Intensive Care. The Journal of Pediatrics, 116, 231-237.
https://doi.org/10.1016/S0022-3476(05)82879-3
[42]
Desikan, S.R., Bray, B., Kurian, J., Ali, S. and Chappel, W. (2007) Outcome after ICU Admission in Patients over Ninety Years Old. Anesthesiology, 107, A33.
[43]
Martin, C. (2015) Choc septique en 2016: Agir vite et bien pour sauver des vies. Journal Européen des Urgences et de Réanimation, 27, 126-127.
https://doi.org/10.1016/j.jeurea.2015.10.010
[44]
Ramnarayan, P., Thiru, K. and Parslow, R.C. (2010) Effect of Specialist Retrieval Teams on Outcomes in Children Admitted to Pediatric Intensive Care Units in England and Wales: à Retrospective Cohort Study. The Lancet, 376, 698-704.
https://doi.org/10.1016/S0140-6736(10)61113-0
[45]
Chen, Y.C., Lin, S.F., Jiang, D.D., Yang, P.C. and Chang, S.C. (2018) Risque-mortalité par unité de soins intensifs chez les patients gravement malades. Journal of the Formosan Medical Association, 77, 1279-1287.
[46]
Morales, I. Peters, S. and Afessa, B. (2003) Hospital Mortality and Length of Stay in Patients Admitted at Night to the Intensive Care Unit. Critical Care Medicine, 4, 203-209.
[47]
Valavi, E., Aminzadeh, M., Shirvani, E., Jaafari, L. and Madhooshi, S. (2018) The Main Causes of Mortality in Pediatric Intensive Care Unit in South West of Iran. Zahedan Journal of Research in Medical Sciences, 3, 82-88.
https://doi.org/10.5812/zjrms.63006
