Abstract
BackgroundImproved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique.MethodsThis was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0–14 years of age seen in the 12-month period from August 2018–July 2019 were included. Descriptive statistical analyses were performed.ResultsData from 346 days and 64,966 patient encounters were analyzed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URI), gastroenteritis, asthma, and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%), and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria, and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED.ConclusionThis epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilisation. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis.
Highlights
Over the past two decades childhood mortality has decreased globally, but gains differ across geographical regions
The goal of this study is to describe the volume, breadth, and severity of illness among patients presenting to the Hospital Central de Maputo (HCM) Paediatric Emergency Department (PED) over the course of one year
There was seasonal variation with the highest mean number of patients seen per day in March (292/day) and the lowest in December (120/day). This variation was largely driven by the volume of respiratory illness, while average daily patient visits for malaria and gastroenteritis were relatively stable over the course of the year (Fig. 1)
Summary
Over the past two decades childhood mortality has decreased globally, but gains differ across geographical regions. While continued expansion of general child health programs such as the Expanded Program on Immunization and Integrated Management of Childhood Illness continue to be key pillars for further reduction of paediatric mortality, there is growing recognition of the importance of improved emergency care for children who present to health facilities with acute illness or injuries [3,4]. Programs such as the World Health Organization's Emergency Triage Assessment and Treatment (ETAT) have been shown to decrease mor tality after being implemented in sub-Saharan African paediatric emergency care centers, as the majority of in-hospital mortality occurs within the first 48 h after presentation [5,6]. The PED may be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis
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