Over an 18 month period, there were 4,720 paediatric admissions at the Eldoret District Hospital in Western Kenya. The most frequent 20 diseases were identified and their respective case fatality rates calculated. Malaria was the most common cause for admission (33.0%) but the fourth most common cause of death with a case fatality rate of 2.2%. The overall mortality rate on the paediatric wards was 8.2% with 64.9% of the deaths occurring within the first 24 hours of hospitalization. Three-fourth of all admissions were due to four diseases: malaria, pneumonia, gastroenteritis and measles. Targeted interventional programmes aimed at these 4 diseases, coupled with a comprehensive primary health care system, would most likely result in much less morbidity and mortality for the children in the district. The systems for routinely collecting and storing medical records were found to be substandard, making it very difficult to accurately monitor morbidity and mortality.
PIP: Over an 18-month period, from October 1991 through early 1993, a study was carried out in two phases in the pediatric wards of the Eldoret District Hospital to document infant and child morbidity and mortality in the Uasin Gishu district and parts of several surrounding districts in western Kenya. Patient discharge summaries and ward registers were analyzed for age, sex, diagnosis, length of hospitalization, and outcome. There were a total 4720 pediatric admissions over the period. The most frequent 20 diseases were identified and their respective case fatalities were calculated. 74.5% of the admissions were due to only four diseases: malaria (33.0%), pneumonia (26.8%), gastroenteritis (10%), and measles (7.6%). Malaria was responsible for only 9 (9.1%) of all deaths. The disease specific mortality rate for malaria was 2.2%, 11th among the top 15 diseases. 20 (20.4%) out of a total of 98 deaths were due to pneumonia. Measles was becoming less important as a cause of morbidity because of immunization: in 1991, over 20 cases/per month were admitted, but by 1993 only 6.5 cases/month were admitted, a decrease of 68%. Neonatal tetanus was responsible for 43.2% of neonatal mortality during the 18 months. In addition, 47 infants and children had severe anemia (hemoglobin 4.0 gm%); 8 (17%) of these children died despite emergency blood transfusions. The overall mortality rate in the hospital during the study was 8.2%, which compares with 9.6% reported in Tanzania in 1987. 61 (64.9%) deaths occurred within 24 hours of hospitalization owing to delay in seeking medical care. In a 1988 study in Harare, 201 (43.7%) of 460 deaths occurred within the first 24 hours of admission. Furthermore, during February through June 1992, 29 of 57 children under 2 years of age admitted for gastroenteritis tested positive for HIV antibodies. A retrospective review of the ward register also showed that in 20% of the admissions the outcome was not recorded, in 25% the length of stay could not be determined, and for 8.3% the age of the patient was not recorded.