Academic journal article Bulletin of the World Health Organization

Etiology of Child Mortality in Goroka, Papua New Guinea: A Prospective Two-Year Study. (Research)

Academic journal article Bulletin of the World Health Organization

Etiology of Child Mortality in Goroka, Papua New Guinea: A Prospective Two-Year Study. (Research)

Article excerpt

Voir page 24 le resume en francais. En la pagina 24 figura un resumen en espanol.

Introduction

Many developing countries, including Papua New Guinea, report aggregated data on hospital discharge diagnoses. Such data contain substantial errors, however, and may not include sufficient detail for assessing quality of care or planning specific interventions. Although they provide a broad view of the case-mix at health facilities, they do not integrate health service performance with outcomes. Infectious diseases cause 70% of the childhood mortality burden in developing countries. Pneumonia, septicaemia, meningitis, and diarrhoeal diseases, which account for more than 4 million deaths annually in children under 5 years of age (1), each have multiple microbial etiologies. Most community-based mortality etiology studies from developing countries have used the technique of verbal autopsy, without microbiological data. Neonatal mortality makes up more than one-third of all child deaths in developing countries; nevertheless, data on the bacterial causes of neonatal deaths are scarce, and details of the relevant diagnoses are frequently ignored in aggregated hospital mortality reports. The emergence of antibiotic-resistant bacteria in health facilities and within communities may be changing the patterns of fatal disease in developing countries. Although a high proportion of all child deaths occurring worldwide could be avoided by simple interventions, there are few published data on what the avoidable factors are or what interventions in health facilities or communities are required.

To gain a better understanding of these issues, we undertook a systematic prospective audit of child mortality in a rural hospital in Papua New Guinea. The aims of the audit were to determine: the age-specific conditions causing death; the microbiological causes of these conditions; the avoidable factors contributing to deaths; and any quantifiable interactions between the conditions and pathogens causing death, and avoidable factors. It was hoped that such an audit might provide a foundation for planning and implementing reforms in child health services.

Methods

Study setting

The study was carried out at Goroka Hospital, in the Eastern Highlands Province of Papua New Guinea, which serves a predominantly rural population of 380 000 inhabitants. Approximately 2000 children and 500 neonates are admitted to the 70-bed paediatric ward of the hospital each year. Children are referred from aid posts and rural health centres, or come direcdy from villages. The above-mentioned audit is an ongoing activity; this article reports a prospective systematic review of consecutive deaths in children who died between 1 April 1998 and 31 March 2000.

Data collection

Whenever a child died, a single-page data sheet was completed outlining the demographic and clinical details, results of all investigations, and potentially avoidable factors. The audit included all in-patient deaths of children from birth to 12 years of age; all children who had died prior to arrival at hospital; and all children with terminal illnesses who were sent home to die. Death was verified in all cases where children were discharged to die at home. Stillborn babies were not included.

Diagnoses were based on pre-defined criteria (2-5). Microbiological information was collected. Samples of blood were collected from severely ill children for bacterial culture at the time of their admission, and at any time thereafter if there was a deterioration in their condition. Children presenting with clinical signs of meningitis underwent a lumbar puncture unless there was a contraindication. For children who died from pneumonia, blood and lung aspirate cultures were done immediately after death if not already undertaken for diagnostic purposes. Specimens were taken using sterile technique, and the laboratory procedures used have been described previously (6, 7). …

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