Predictors of mortality among children at Tertiary Hospital in Tanzania: A cohort study

Abstract

Abstract Background Tanzania is among the countries in the sub-Saharan Africa with the highest under-five mortality rate. Strategies for reducing under-five mortality require a good knowledge of driving factors, which are largely unknown necessitating this study to be conducted at Muhimbili National Hospital to determine factors associated with under-five mortality. Method We conducted a prospective cohort study to determine the predictors of deaths among children aged 1–59 months admitted in the paediatric department wards from October 2017 to April 2018. We recruited children consecutively and followed them up until discharge or death. We calculated the mortality rate as the incidence density rate, and determined causes and predictors of mortality. We analysed data to identify and quantify predictors of deaths, and used Kaplan-Meir and Cox regression analyses to determine predictors of survival. A P-value of < 0.05 was considered statistically significant. Results We recruited 925 children aged 1–59 months with a median age of 13 and (IQR) of (6, 26) months, females constituted 40.8% (377/925). The overall mortality rate was 12.2% (95% CI: 10.2%-14.5%). We found septicaemia (27%), malnutrition (12%), congenital heart disease (12%), pneumonia (11%), and HIV (9%) to be leading causes of mortality. More deaths were observed at night, during the first 24 hours of admission, and on weekends. Independent factors for mortality were found to be low wealth quintiles (lowest quintile (AOR = 4.0; 95% CI: 1.19–13.51), second quintile (AOR = 5.2; 95% CI: 1.65–16.69) and middle quintile (AOR = 3.6; 95% CI: 1.14–11.33)), unconsciousness on admission (AOR = 18; 95% CI: 6.70-56.82), inability to feed (AOR = 5.7; 95% CI: 1.97–16.51), lethargy (AOR = 4.9; 95% CI: 2.32–10.40), severe wasting (AOR = 4.5; 95% CI: 2.49–8.10) and respiratory distress (AOR = 2.6; 95% CI: 1.40–4.97) Conclusion High mortality rate was noted in this study and low wealth quantile, low parental education, and lack of health insurance were associated with high mortality. Patients had the highest risk of mortality within 24 hours of admission, therefore it is important to raise awareness and improve monitoring of patients, especially within 24 hours of admission.