under five mortality patterns in an urban area: a hospital based study in dar es salaam tanzania...
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Under Five Mortality Patterns in an Urban Area: A Hospital Based Study in Dar es
Salaam Tanzania (2008-2010)
Kishimba R, Mohamed I1, Mohamed MA1,2,Mghamba JM1,2, Simba A1,2, Ngware Z1,2 , Senga S1,2, Mmbuji P1,2
1. Field Epidemiology and Laboratory Training Program, Tanzania
2. Ministry of Health and Social Welfare
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Background
• Childhood mortality is declining in the developing world, but is still high compared to developed countries
• In Tanzania, trend for < 5 mortality has decreased in the past 2 years, from 143/1,000 in 2005 to 106/1,000 in 2007
• Factors contributing to declining < 5 mortality: – Increased immunisation– Diarrhoeal diseases control– Malaria control– Control of acute respiratory tract infections– Improved Perinatal Care
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Rationale• Previous studies on morbidity and mortality in childhood
conducted in Tanzania have been limited to certain diseases like anemia, malaria and pneumonia
• However, detailed epidemiologic data from hospital is lacking on causes of morbidity and mortality in Tanzania
• Hospital statistics may provide an insight on general cause-specific morbidity and mortality patterns
• Such information can go a long way in reorienting– Services – Nature and quantum of therapeutic agents required– Kind of nursing needed
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Research objectives
• Describe the current pattern of <5 mortality in an urban district hospital, providing:– Understanding of causes of mortality in this urban
population
• Compare patterns between years , to bring out;– Specific patterns/trends of this population served by this
hospital
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Study Design and Data Collection
• Cross sectional study
• Study area: Amana Municipal Hospital
• Review of pediatric in-patient death registers, 2008-2010.
• Information abstracted: age, sex, place of domicile, year of death, and primary cause of death
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Data Analysis• Epi info 2000 and Stata version 11 were used
for data analysis
• Indices calculated: Proportionate mortality ratio (PMR)
• Chi-square test was used to test significance of difference between two proportions
• p<0.05 was taken as a measure of statistical significance
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Medical Records, Amana Hospital
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Results• Between 2008-2010:– 21,085 under-five were admitted
– 1,397 under-five died (Overall <5 mortality rate was 6.6 per 100 admissions)
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PMR for 5 top diseases among < 5 years, Amana district hospital, 2008-2010
(N=1,397)
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PMR of other diseases
• Proportional mortality ratio of other diseases apart from top 5 are;– Malnutrition 5.4%– Septicemia 4.2%– Others (Asthma, Sickle Cell Disease, Congenital
Heart Disease, Meningitis, Pulmonary TB, Poison) 5.9%
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PMR trend of 5 top diseases among < 5 years, Amana hospital, 2008-2010
(N=1,397)
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PMR trend of 5 top diseases among infants, Amana hospital, 2008-2010
(N=834)
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Limitation• Cross sectional data
• Lack of defined hospital based surveillance which could be used as a base for extraction of relevant information
• Missed information from the existing records
• Hospital data not representative of general population. However they are relevant in;– Hospital planning– Potential clinical intervention evaluation
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Conclusion• Pneumonia deaths is a leading
cause of death in all years with no significant change
• Acute watery diarrhea PMR for under-fives decreased
• HIV/AIDS PMR for under-fives increased
• Infants and older children had an increase in Malaria PMR, but it was only infant that was significant
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Comparison with other developing countries• Hospital based < 5 mortality rate was found to be 6.6%.
However, overall < 5 mortality rate in Tanzania is 8.1% (TDHS, 2010)
• This study found found major causes of death to < 5 were pneumonia, malaria, anaemia and HIV/AIDS
• Other studies from developing countries also showed similar findings– Lagos State, Nigeria {(Rasheed K. O, October 2008), – Burkina Faso (Gaël P Hammer at al 2006)– West Africa (Heiko Becher at al January 2008), – Nigeria (George I. O at al 2009), – West Africa (Robert P Ndugwa at al 2008),
– Nairobi, Kenya (Yazoume Ye at al November 2009)}
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Public Health Implications• High prevalence of deaths attributed to pneumonia calls for
an evaluation of - The newly established Pentavalent (DPTHB-Hib) vaccine program- Adequacy of equipments and supplies for case management- Best practice for pneumonia case management
• Ongoing strategies for malaria management for infants may require revision.
• Ministry of Health should ensure availability of lab equipments and supplies (MRDT KITS)
• Potential causes for the increase in HIV/AIDS mortality among under-fives needs to be further explored
• There is a need of establishment of hospital based electronic surveillance
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Acknowledgement
• Ministry of Health and Social Welfare (MoHSW)
• Tanzania Field Epidemiology and Laboratory Training Program (TFELTP)
• Centre for Disease Control and Prevention (CDC)
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THANK YOU FOR
YOUR ATTENTIO
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