COMPARATIVE ANALYSIS OF CHILDHOOD DEATHS IN OOUTH: IMPLICATIONS FOR THE FOURTH MDG DEPARTMENT OF PAEDIATRICS OLABISI ONABANJO UNIVERSITY

TY TEACHING HOSPITAL, SAGAMU

Children are the heritage from God.. And a reward from Him. Like arrows in the hands of a warrior.. Psalm 127: 3 - 5

Introduction Nearly 10 million children under five die globally every year. These deaths are most common in Sub-Saharan Africa and Asia. The MDGs resulted from the United Nations Millennium Summit of September 2000 aimed at reducing global poverty & improving the lives of people. The Fourth MDG (out of eight) aims to reduce 1990 Under-5 Deaths by 2/3 by the year 2015. Current National Vital Statistics Under-Five MR Rank 18th Under-Five MR 138/1000 LB Infant MR 86/1000 LB Neonatal MR 39/1000 LB Comparison of National Childhood Mortality Rates Comparison of U5MR of Nigeria, Ghana, India & UAE Introduction All hands must be on deck to achieve that goal. Appraisal of the current situation is essential to identify challenges & allow adequate planning. Objectives To determine the mortality pattern among children hospitalized in OOUTH To determine the leading causes of childhood death in OOUTH over a 10-year period To compare the pattern of childhood deaths in the Pre-MDG and MDG periods in OOUTH Methods Hospital records of children admitted into the three pediatric wards of OOUTH were studied.

 Clinical & laboratory details were recorded and analyzed Mortality pattern in the Pre-MDG period (1996-2000) were statistically compared with the MDG period (2001-2005) Summary of Findings Total admission 10, 541 (4,127 Vs 6,414) Total death 1,320 (Only 1,225 available) Overall childhood mortality rate = 12.5% (Range of 10.7% to 14.9%) Sex distribution: M = 707 F = 518 with M:F ratio of 1.4:1 69.1% died within 48 hours of hospitalization Overall Yearly Mortality Rate Age distribution of Childhood Mortality Summary of Findings Neonates formed 57.3% of all Childhood deaths & 63.9% of Under-5 deaths Neonates formed 77.9% of all infants deaths Infant deaths formed 83% of all Under-Five deaths Under-Five deaths formed 89.6% of all childhood deaths Neonatal Mortality Per 1000 Admissions Mortality Rates & Places of Delivery Neonatal Mortality Rates based on Deliveries in OOUTH Comparison of Early & Late NMR based on Deliveries in OOUTH Causes of Death in the Newborn Period Multiple Birth Injuries Causes of Death in Infants aged >28days 12mo Causes of Death in Children aged 12mo - 5 yrs Causes of Death in Children aged 5yrs -16yrs Comparison of Mortality Rates in the Pre-MDG & MDG periods Comparison of the causes of Death in the Pre-MDG and MDG periods Causes of death in the Pre-MDG and MDG periods in Sagamu Key Points No remarkable difference in the Overall Childhood Mortality over the two periods studied. Post-neonatal mortality was also similar for the two periods. Neonatal mortality increased in the MDG period!!!! Most deaths occur within 48 hrs of admission (issue of delayed presentation) Key Points Severe asphyxia in the MDG period (poor utilization of QUALITY maternity services) Prematurity in the MDG period ( socio-economic stress, infrastructural supports for their care) Neonatal jaundice in the MDG period (delayed presentation, wrong use of home remedies) Neonatal tetanus ( awareness, some TBHs give TT) Key Points Severe anaemia in the MDG period (related to in malaria) Severe Malaria in the MDG period (possible success of interventions: RBM, ITN, IPT) Tuberculosis in the MDG period ( awareness and better organized NTBLCP) PEM & Diarrheal diseases in the MDG period ( acceptability & utilization of ORT) HIV/AIDS in the MDG period ( awareness)

 Why do children die? Health Status of Nigerian Children Specific Requirements Efficient and affordable Antenatal Care services Clean birthing: clean hands, clean kits & clean surfaces Effective and safe resuscitation at birth Prompt detection and treatment of jaundice Thermal Care (Warm Chain, Kangaroo Mother Care technique) Training and re-training Neonatal Intensive Care Specific Requirements Integrated Management of Childhood & Neonatal Illnesses (Community Involvement) Improved vaccination Malaria control (ACT, ITN, IPT) Early diagnosis & Treatment of Pneumonia Prevention & Treatment of Diarrhoea Improved Blood Banking Services PMTCT Pleasant experience.... FROM A BEAUTIFUL BABY. TO A BEAUTIFUL SCHOOL GIRL Many things can wait. .but the child CANNOT wait. ..NOW is the time his bones are being formed His mind is being formed.. To him, we cannot say TOMORROW; .His name is TODAY Gabriella Mistral THANK YOU!