In-patient mortality analysis following establishment of a separate pediatric emergency care in Eastern Nepal

Abstract

Objective: High quality hospital care for sick neonates, infants and older children are not readily available and is highly demanding in low- middle income countries. It results in high childhood mortality in resource- limited settings. We hypothesize that interventions in the form of creation of separate pediatric emergency care can prevent in-patient hospital mortality. Methods: The intervention initiatives undertaken in pediatric emergency care were: (i)- creation of new pediatric emergency care block adjacent to the general ward, (ii)-allocation of resident doctors supporting at triage and stabilization of patients before transfer to the ward and (iii)- availability of life saving medical equipment and monitoring in emergency care block. Primary outcome measure was to assess in-patient hospital mortality and mortality within 48 hours, one year before (September 2012- August 2013) and a year after the intervention (October 2013- September 2014). Results: The total deaths of patients decreased from 6.27% to 5.19% during the later period (RR 0.89, 95% CI 0.81-0.99, P=0.019). Deaths within 48 hours also decreased from 4.29% to 3.42% (RR 0.88, 95% CI 0.78- 0.99, P= 0.021). Reduction in neonatal deaths also followed the similar trend (0.88, 95% CI 0.77-0.99, P =0.032). Overall pattern of diseases, except central nervous system involvement (6.66% vs 5.44%, P 0.009), and duration of hospital stay remained same during both the study periods. Conclusions: Thus, there was a significant reduction in in-patient pediatric mortality after creation of separate pediatric emergency facility. Such measures can be undertaken to reduce childhood mortality.