A pediatric death audit in a large referral hospital in Malawi

26Citations
Citations of this article
134Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Background: Death audits have been used to describe pediatric mortality in under-resourced settings, where record keeping is often a challenge. This information provides the cornerstone for the foundation of quality improvement initiatives. Malawi, located in sub-Saharan Africa, currently has an Under-5 mortality rate of 64/1000. Kamuzu Central Hospital, in the capital city Lilongwe, is a busy government referral hospital, which admits up to 3000 children per month. A study published in 2013 reported mortality rates as high as 9%. This is the first known audit of pediatric death files conducted at this hospital. Methods: A retrospective chart review on all pediatric deaths that occurred at Kamuzu Central Hospital (excluding deaths in the neonatal nursery) during a 13-month period was done using a standardized death audit form. A descriptive analysis was completed, including patient demographics, HIV and nutritional status, and cause of death. Modifiable factors were identified that may have contributed to mortality, including a lack of vital sign collection, poor documentation, and delays in the procurement or results of tests, studies, and specialist review. Results: Seven hundred forty three total pediatric deaths were recorded and 700 deceased patient files were reviewed. The mortality rate by month ranged from a low of 2.2% to a high of 4.4%. Forty-four percent of deaths occurred within the first 24h of admission, and 59% occurred within the first 48h. The most common causes of death were malaria, malnutrition, HIV-related illnesses, and sepsis. Conclusions: The mortality rate for this pediatric referral center has dramatically decreased in the 6years since the last published mortality data, but remains high. Areas identified for continued development include improved record keeping, improved patient assessment and monitoring, and more timely and reliable provision of testing and treatment. This study demonstrates that in low-resource settings, where reliable record keeping is often difficult, death audits are useful tools to describe the sickest patient population and determine factors possibly contributing to mortality that may be amenable to quality improvement interventions.

References Powered by Scopus

Mortality after fluid bolus in African children with severe infection

1286Citations
N/AReaders
Get full text

A scandal of invisibility: making everyone count by counting everyone

348Citations
N/AReaders
Get full text

Quality of hospital care for seriously ill children in less-developed countries

323Citations
N/AReaders
Get full text

Cited by Powered by Scopus

A holistic approach to the mycetoma management

60Citations
N/AReaders
Get full text

Paediatric deaths in a tertiary government hospital setting, Malawi

14Citations
N/AReaders
Get full text

Risk factors for mortality and management of children with complicated severe acute malnutrition at a tertiary referral hospital in Malawi

13Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Fitzgerald, E., Mlotha-Mitole, R., Ciccone, E. J., Tilly, A. E., Montijo, J. M., Lang, H. J., & Eckerle, M. (2018). A pediatric death audit in a large referral hospital in Malawi. BMC Pediatrics, 18(1). https://doi.org/10.1186/s12887-018-1051-9

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 35

56%

Researcher 16

25%

Lecturer / Post doc 7

11%

Professor / Associate Prof. 5

8%

Readers' Discipline

Tooltip

Medicine and Dentistry 41

68%

Nursing and Health Professions 8

13%

Social Sciences 6

10%

Immunology and Microbiology 5

8%

Save time finding and organizing research with Mendeley

Sign up for free