Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi

Abstract

In low-resource settings, many children are severely ill at arrival to hospital. The risk factors for mortality among such ill children are not well-known. Understanding which of these patients are at the highest risk could assist in the allocation of limited resources to where they are most needed. A cohort study of severely ill children treated in the resuscitation room of the pediatric emergency department at Queen Elizabeth Central Hospital in Malawi was conducted over a 6-month period in 2017. Data on signs and symptoms, vital signs, blood glucose levels, and nutritional status were collected and linked with in-hospital mortality data. The factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Data for 1,359 patients were analyzed and 118 (8.7%) patients died. The following factors were associated with mortality: presence of any severely deranged vital sign, unadjusted odds ratio (UOR) 2.6 (95% CI 1.7-4.0) and adjusted odds ratio (AOR) 3.2 (95% CI 2.0-5.0); severe dehydration, UOR 2.6 (1.4-5.1) and AOR 2.8 (1.3-6.0); hypoglycemia glycemia (< 5 mmol/L), UOR 3.6 (2.2-5.8) and AOR 2.7 (1.6-4.7); and severe acute malnutrition, UOR 5.8 (3.5-9.6) and AOR 5.7 (3.3-10.0). This study suggests that among severely sick children, increased attention should be given to those with hypo/low glycemia, deranged vital signs, malnutrition, and severe dehydration to avert mortality among these high-risk patients.

Figure 1.

Classification of severely deranged vital signs by age.