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 givena 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.