Disclosures None Pediatric Morbidity and Mortality at Yala Sub - PDF document

Disclosures • None Pediatric Morbidity and Mortality at Yala Sub ‐ Country Hospital Julian Thomas Harvard Medical School 8 May 2014 Take Home Points Outline • The leading causes of under ‐ 5 mortality are • Background preventable and treatable • Child Mortality • U5M at YSDH can be reduced • Methods using existing resources • Results • Discussion Child Health Improved Indicators  MDG #4: Reduce Child Mortality by 2/3 between • Antenatal care 1990 and 2015 • Hospital Deliveries  Kenya has made progress • Immunization campaigns – U5MR: 115 in 2002 to 73 in 2012 • Insecticide treated nets – IMR: 75 in 2002 to 49 in 2012 • Malezi Bora “Good Nurturing” • Still behind on MDG 4

Outline Child Mortality in Kenya 140 • Background 120 • Child Mortality in Kenya Deaths per 1000 children 100 • Methods 80 • Results 60 IMR • Discussion U5MR 40 20 0 1990 1998 2003 2006 2008 2012 MDG KIHBS target 2015 Preventable and Treatable Disproportionate Burden • 2010: 188,928 under ‐ 5 deaths • Top causes of death Eastern 52 North – Diarrhea, 20% Eastern Rift 80 – Pneumonia, 16% Valley Western 59 121 – Malaria, 11% Kenya 74 Central – Prematurity, 10% Nyanza 51 149 – Birth Asphyxia, 10% Coast Deaths per 1,000 live 87 Nairobi births for the 10 ‐ year 64 period before the survey Siaya County Child Mortality: Crisis • 1 in every 9 children born in Siaya County dies before • Stagnating child mortality rates their first birthday • Devolution and shifting responsibilities • 1 in every 6 does not survive to age five • End of Millennium Development Project • Solutions are needed at all levels Kenya National Bureau of Statistics. 2013. Siaya County Multiple Indicator Cluster Survey 2011, Final Report. Nairobi, Kenya: Kenya National Bureau of Statistics.

Purpose Outline • Describe the morbidity and mortality of patients ages • Background 0 to 15 years admitted to Yala Sub ‐ Country Hospital • Child Mortality • Methods • Results • Discussion Design Patient Data • Retrospective assessment of Pediatric Ward • Admission date discharges from January 2013 to December 2013 • Discharge date • Age • Sex • Diagnoses • Mortality Outline Included patients • Background 900 Patients 17 Missing data: • Child Mortality Admission Date 5 • Discharge Date 12 • • Methods 883 with admission data • Results 7 Missing data: age 3 • • Discussion Sex 4 • 876 with complete data 2 Older than 15 years 874 less than 15 years old

Patient Characteristics Discharge Diagnoses Meningitis Pneumonia 3% 7% Diarrhea Upper Respiratory 6% Tract Infection Anemia 2% Dehydration 11% 2% Malnutrition 3% Illegible Burn 1% Neonatal Sepsis 1% Other Asthma Exacerbation 10% 1% Convulsion 0% Malaria Sepsis 56% 0% Malaria Admissions Most Frequent Diagnoses by Month 100 19 (Excluding Malaria) Min Temp, C 18 Malaria 80 50 17 70 16 60 Anemia 0 15 Pneumonia 50 Number 100 250 Gastroenteritis/Diarrhea 40 Rainfall, mm Malnutrition 80 200 Malaria 30 Meningitis 60 150 URTI 20 40 100 Dehydration 10 20 50 Burn 0 0 0 Jan ‐ 13 Feb ‐ 13 Mar ‐ 13 Apr ‐ 13 May ‐ 13 Jun ‐ 13 Jul ‐ 13 Aug ‐ 13 Sep ‐ 13 Oct ‐ 13 Nov ‐ 13 Dec ‐ 13 Figure 3 Mortality Outline Mortality 0 ‐ 15 Infant Under 5 • Background years Mortality Mortality Malnutrition 9 Malnutrition 3 Malnutrition 5 • Child Mortality Anemia 8 Anemia 1 Anemia 6 Malaria 8 Malaria 1 Malaria 6 • Methods Pneumonia 3 Pneumonia 1 Pneumonia 2 • Results Not listed 2 Not listed 1 Abscess 1 Abscess 1 • Discussion Burn 1 Asphyxia 1 Asphyxia 1 Gastroenteritis 1 Gastroenteritis 1 Sepsis 1 Sepsis 1 Dehydration 1 Dehydration 1

Discussion Limitations • Report provides critical information about • Missing data pediatric admissions – Omitted or destroyed • May inform new approaches to preventing • Cause of death pediatric morbidity and mortality – Chart review would be useful Relevance to Providers Areas of Improvement • Western Kenya has a disproportionate burden • Review malnutrition and anemia mortalities • The leading causes of death nationwide are • Missed opportunities for parent education readily preventable and treatable • Consider “flexing up” staff during rainy seasons • National guidelines exist • GE Foundation and NMF should offer more • What are current quality assurance activities? than medical students – Physicians, nurse managers, administrators Take Home Points Acknowledgements • The leading causes of under ‐ 5 mortality are • Prof. Odero preventable and treatable • Yala Sub ‐ County Hospital • U5M at YSDH can be reduced • GE ‐ NMF using existing resources • #teamyala