A hospital-based estimate of major causes of death among under-five children from a health facility in Lagos, Southwest Nigeria: possible indicators of health inequality

Abstract

Introduction: Current evidence on the root-causes of deaths among children younger than 5 years is critical to direct international efforts to improve child survival, focus on health promotion and achieve Millennium Development Goal 4. We report a hospital-based estimate for 2005-2007 of the major causes of death in children in this age-group in south-west Nigeria.

Methods: We used retrospective data from the intensive care unit of a second-tier health facility to extract the presenting complaints, clinical diagnosis, treatment courses, prognosis and outcome among children aged 6-59 months. SPSS-19 was used for data analysis.

Results: Of the 301 children (58% males, 42% females) admitted into the ICU within the period of study, 173 (26%) presented with complaints related to the gastrointestinal system, 138 (21%) with respiratory symptoms and 196 (29%) with complaints of fever. Overall, 708 investigations were requested for among which were full blood count (215, 30%) and blood slides for malaria parasite (166, 23%). Infection ranked highest (181, 31%) in clinicians' diagnosis, followed by haematological health problems (109, 19%) and respiratory illnesses (101, 17%). There were negative correlations between outcome of the illness and patient's weight (r=-0.195, p=0.001) and a strong positive correlation between prognosis and outcome of admission (r=0.196, p=0.001). Of the 59 (20%) children that died, presentation of respiratory tract illnesses were significantly higher in females (75%) than in males (39%) (χ²=7.06; p=0.008) and diagnoses related to gastrointestinal pathology were significantly higher in males (18%) than in females (0%) (χ²=4.07; p=0.05). Majority of the deaths (21%) occurred among children aged 1.0 to 1.9 years old and among weight group of 5.1-15.0 kg.

Conclusion: The major causes of deaths among under-five years old originate from respiratory, gastrointestinal and infectious diseases - diseases that were recognized as major causes of childhood mortality about half a century earlier. Realization of MDG4 - to reduce child mortality by two-thirds - is only possible if the government and donor agencies look beyond the health sector to find hidden causative factors such as education and housing and within the health sector such as vibrant maternal, new-born, and child health interventions.

Figure 1

Per cent systemic and general complaints at intensive care unit relative to age group (years).

Figure 2

Presenting complaints of survey children that died in intensive care unit of a secondary healthcare facility in Lagos.

Figure 3

Clinicians’ diagnoses of survey children prior to death at the intensive care unit of a secondary healthcare facility in Lagos.

Figure 4

(a). Prognosis of under-fives in ICU (i) all patients relative to age group (ii). Prognosis of under-fives in ICU (ii) male patients relative to age group. iii. Prognosis of under-fives in ICU female patients relative to age group (b). Per cent prognostic values relative to age group of children admitted into ICU. (c) Percent prognostic values among children that died in the ICU.

Figure 5

a. Outcome of male admission into intensive care unit according to age group. b. Outcome of female admission into intensive care unit according to age group.