Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan.
BMJ Open. 2024 Aug 22;14(8):e082255. doi: 10.1136/bmjopen-2023-082255.
To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan.
Prospective cohort study.
Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020.
3850 children 0-14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department.
The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment.
Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age <28 days) was associated with increased odds of death (OR 4.34 [95% CI 2.38 to 8.18], p<0.001, reference age 28 days-14 years) and there was no significant difference in odds of death between female vs male children (OR 1.12, 95% CI 0.6 to 2.04, p=0.72). 47 children died in the hospital (3.6%) and three (0.2%) died within 28 days of admission. Most children who died were <28 days old (n=32/50, 64%); leading diagnoses included neonatal sepsis/meningitis (n=13/50, 26%), neonatal encephalopathy (n=7/50, 14%) and lower respiratory tract infections (n=6/50, 12%). Delays in care-seeking (n=15) and in receiving appropriate treatment (n=12) were common.
This study adds to sparse literature surrounding the epidemiology of disease and hospital outcomes for children with acute illness seeking healthcare in rural Pakistan and, in particular, among children aged 5-14 years. Further studies should include public and private hospitals within a single region to comprehensively describe patterns of care-seeking and interfacility transfer in district health systems.
描述在巴基斯坦一个地区总部医院就诊的急性病患儿的就诊年龄、性别及病死率，并按年龄分类。
前瞻性队列研究。
2019 年 12 月至 2020 年 4 月和 2020 年 8 月至 12 月，在巴基斯坦信德省桑加尔区总部医院的急诊和门诊以及住院部。
3850 名 0-14 岁因急性病就诊于急诊和门诊的儿童，以及 1286 名收入住院部的儿童。
全球疾病负担诊断类别。次要结局包括 28 天病死率、死因和医疗延误，定义为寻求治疗的延误、到达医疗机构的延误和适当治疗的延误。
在门诊和 1 个月至 9 岁住院患儿中，最常见的就诊诊断为传染病。随着年龄的增长，非传染性疾病和营养障碍更为常见。很少有儿童因受伤就诊。新生儿期（<28 天）与死亡风险增加相关（比值比 4.34[95%CI 2.38 至 8.18]，p<0.001，参考年龄为 28 天-14 岁），女性与男性患儿的死亡风险无显著差异（比值比 1.12[95%CI 0.6 至 2.04]，p=0.72）。住院期间有 47 名儿童死亡（3.6%），3 名（0.2%）在入院后 28 天内死亡。大多数死亡的患儿年龄<28 天（n=32/50，64%）；主要诊断包括新生儿败血症/脑膜炎（n=13/50，26%）、新生儿脑病（n=7/50，14%）和下呼吸道感染（n=6/50，12%）。寻求治疗（n=15）和接受适当治疗（n=12）的延误很常见。
本研究增加了农村巴基斯坦儿童急性病就诊的疾病流行病学和医院结局方面的文献，特别是 5-14 岁儿童。进一步的研究应包括单一地区的公立和私立医院，以全面描述在地区卫生系统中寻求治疗和机构间转移的模式。
