Mortalidade em hospital secundário pediátrico na Libéria pós-conflito em 2009

Abstract

Objective:To describe and analyze the causes of death in a pediatric secondary-care hospital (run by Médecins sans Frontières), in Monrovia, Liberia, 6 years post-civil war, to determine the quality of care and mortality in a setting with limited resources.Methods:Data were retrospectively collected from March 2009 to October 2009. Patient charts and laboratory records were reviewed to verify cause of death. Additionally, charts of patients aged over 1 month with an infectious cause of death were analyzed for decompensated septic shock, or fluid-refractory septic shock.Results:Of 8,254 admitted pediatric patients, 531 died, with a mortality rate of 6.4%. Ninety percent of deaths occurred in children <5 years old. Most deaths occurred within 24 hours of admission. The main cause of death (76%) was infectious disease. Seventy-eight (23.6%) patients >1 month old with infectious disease met the criteria for septic shock, and 28 (8.6%) for decompensated or fluid-refractory septic shock.Conclusion:Since the end of Liberia's devastating civil war, Island Hospital has improved care and mortality outcomes, despite operating with limited resources. Based on the available data, mortality in Island Hospital appears to be lower than that of other Liberian and African institutions and similar to other hospitals run by Médecins sans Frontières across Africa. This can be explained by the financial and logistic support of Médecins sans Frontières. The highest mortality burden is related to infectious diseases and neonatal conditions. The mortality of sepsis varied among different infections. This suggests that further mortality reduction can be obtained by tackling sepsis management and improving neonatal care.

Pediatric Mortality in a Rural Tertiary Care Center in Liberia

“…In contrast, Liberia saw an opposite trend, with higher pediatric mortality rates during the war compared to the immediate post-war period [ 2 ]. Our data corroborates this trend, with lower in-hospital mortality reported 10 years post-war compared to immediately post-war [ 4 , 5 ]. Additionally, the higher mortality rate in Nigeria may reflect more acutely ill patients presenting due to the presence of a pediatric intensive care unit, which was not available in our setting, or a better prehospital transport system, which allowed these patients to reach the hospital faster.…”

“…The higher mortality rates immediately post-war likely reflect the sequelae of the war’s effect on health infrastructure and overall child health. The mortality rate we report 10 years after the war may reflect a new baseline in the post-war, pre-Ebola era in Liberia, given the similarity to what was reported six years post-war [ 4 ].…”

“…The overall mortality rate was relatively low even in this setting without a pediatric intensive care unit. Despite limited resources, the mortality rate of 5.4% is comparable to the 6.4% described at Island Hospital in urban Monrovia in 2009 and lower than the 13.1% described at Mamba Point Hospital in 2005, one year post-war [ 4 , 5 ]. Multiple hospitals in Monrovia reported higher mortality rates of 11%, 14%, and 17% [ 5 ].…”

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

“…This research also adds to the existing knowledge base, because emergency facility mortality in Liberia has not been previously reported. Mortality in emergency facilities in other Sub-Saharan LMICs is estimated to be 3.4% [40]. In other healthcare settings in Liberia, a wide mortality range has been described, from 23.3% at a referral hospital in Monrovia shortly after the end of the civil conflicts, to 7.4% surgical ward mortality at JFKMC, the national medical center of Liberia [41].…”