Harris Caroline, Mills Rowena, Seager Ezgi, Blackstock Sarah, Hiwa Tamanda, Pumphrey James, Langton Josephine, Kennedy Neil
Department of Paediatrics, Great North Children's Hospital , Newcastle-upon-Tyne , UK.
Department of Paediatrics, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust , Birmingham , UK.
Paediatr Int Child Health. 2019 Nov;39(4):240-248. doi: 10.1080/20469047.2018.1536873. Epub 2018 Nov 19.
: Malawisuccessfully achieved Millennium Development Goal (MDG) four by decreasing the under-5 mortality rate by two-thirds in 2012. Despite this progress child mortality is still high and in 2013, the leading causes of death in under-5s were malaria, acute respiratory infections and HIV/AIDS. : To determine the causes of inpatient child death including microbiological aetiologies in Malawi. : A prospective, descriptive study was undertaken in Queen Elizabeth Central Hospital over 12 months in 2015/2016. Data was collected for every paediatric covering HIV and nutritional status, cause of death, and microbiology. Deaths of inborn neonates were excluded. : Of 13,827 admissions, there were 488 deaths, giving a mortality rate of 3.5%. One-third of deaths (168) occurred in the first 24 h of admission and 255 after 48 h Sixty-eight per cent of those who died (332) were under 5 years of age. The five leading causes of death were sepsis (102), lower respiratory tract infection (67), acute gastroenteritis with severe dehydration (51), malaria (37) and meningitis (34). The leading non-communicable cause of death was solid tumour (12). Of the 362 children with a known HIV status 134 (37.0%) were HIV-infected or HIV-exposed. Of the 429 children with a known nutrional status, 93 had evidence of severe acute malnutrition (SAM). Blood cultures were obtained from 252 children 51 (20.2%) grew pathogenic bacteria with and being the most common. : Despite a significant reduction in paediatric inpatient mortality in Malawi, infectious diseases remain the predominant cause. ART: anti-retroviral therapy; Child PIP: Child Healthcare Problem Identification Programme; CCF: congestive cardiac failure; CNS: central nervous system; CoNS: coagulase-negative ; CSF: cerebrospinal fluid; DNA pcr: deoxyribonucleic acid polymerase chain reaction; ETAT: emergency triage assessment and treatment; LMIC: low- and middle-income countries; MDG: Millennium Development Goals; MRI: magnetic resonance imaging; MRSA: methicillin-resistant ; NAI: non-accidental injury; NTS: non-typhi salmonella; PJP: pneumonia; PSHD: presumed severe HIV disease; QECH: Queen Elizabeth Central Hospital; RHD: rheumatic heart disease; RTA: road traffic accident; TB: tuberculosis; TBM: tuberculous meningitis; WHO: World Health Organization; SAM: severe acute malnutrition.
马拉维在2012年成功实现了千年发展目标4，将5岁以下儿童死亡率降低了三分之二。尽管取得了这一进展，但儿童死亡率仍然很高，2013年，5岁以下儿童的主要死因是疟疾、急性呼吸道感染和艾滋病毒/艾滋病。
为了确定马拉维住院儿童死亡的原因，包括微生物病因。
2015/2016年在伊丽莎白女王中央医院进行了一项为期12个月的前瞻性描述性研究。收集了每个儿科患者的艾滋病毒和营养状况、死亡原因及微生物学数据。排除了先天新生儿死亡病例。
在13827例入院病例中，有488例死亡，死亡率为3.5%。三分之一的死亡病例（168例）发生在入院后的头24小时内，48小时后有255例死亡。死亡儿童中有68%（332例）年龄在5岁以下。主要死因包括败血症（102例）、下呼吸道感染（67例）、伴有严重脱水的急性肠胃炎（51例）、疟疾（37例）和脑膜炎（34例）。主要的非传染性死因是实体瘤（12例）。在362名已知艾滋病毒感染状况的儿童中，134名（37.0%）感染了艾滋病毒或接触过艾滋病毒。在429名已知营养状况的儿童中，93名有严重急性营养不良（SAM）的证据。从252名儿童身上采集了血培养样本，51名（20.2%）培养出致病细菌，其中[具体细菌名称1]和[具体细菌名称2]最为常见。
尽管马拉维儿科住院死亡率大幅下降，但传染病仍然是主要死因。
抗逆转录病毒疗法；儿童医疗保健问题识别计划；充血性心力衰竭；中枢神经系统；凝固酶阴性[细菌名称]；脑脊液；脱氧核糖核酸聚合酶链反应；紧急分诊评估与治疗；低收入和中等收入国家；千年发展目标；磁共振成像；耐甲氧西林[细菌名称]；非意外伤害；非伤寒沙门氏菌；[卡氏肺孢子虫]肺炎；推测的严重艾滋病毒疾病；伊丽莎白女王中央医院；风湿性心脏病；道路交通事故；结核病；结核性脑膜炎；世界卫生组织；严重急性营养不良
