Under Five Mortality Patterns in an Urban Area: A Hospital Based Study in Dar es Salaam Tanzania ( ) Kishimba R, Mohamed I 1, Mohamed MA 1,2,Mghamba JM 1,2, Simba A 1,2, Ngware Z 1,2, Senga S 1,2, Mmbuji P 1,2 1. Field Epidemiology and Laboratory Training Program, Tanzania 2. Ministry of Health and Social Welfare

Background Childhood mortality is declining in the developing world, but is still high compared to developed countries In Tanzania, trend for < 5 mortality has decreased in the past 2 years, from 143/1,000 in 2005 to 106/1,000 in 2007 Factors contributing to declining < 5 mortality: – Increased immunisation – Diarrhoeal diseases control – Malaria control – Control of acute respiratory tract infections – Improved Perinatal Care

Rationale Previous studies on morbidity and mortality in childhood conducted in Tanzania have been limited to certain diseases like anemia, malaria and pneumonia However, detailed epidemiologic data from hospital is lacking on causes of morbidity and mortality in Tanzania Hospital statistics may provide an insight on general cause- specific morbidity and mortality patterns Such information can go a long way in reorienting – Services – Nature and quantum of therapeutic agents required – Kind of nursing needed

Research objectives Describe the current pattern of <5 mortality in an urban district hospital, providing: – Understanding of causes of mortality in this urban population Compare patterns between years, to bring out; – Specific patterns/trends of this population served by this hospital

Study Design and Data Collection Cross sectional study Study area: Amana Municipal Hospital Review of pediatric in-patient death registers, Information abstracted: age, sex, place of domicile, year of death, and primary cause of death

Data Analysis Epi info 2000 and Stata version 11 were used for data analysis Indices calculated: Proportionate mortality ratio (PMR) Chi-square test was used to test significance of difference between two proportions p<0.05 was taken as a measure of statistical significance

Medical Records, Amana Hospital

Results Between : – 21,085 under-five were admitted – 1,397 under-five died (Overall <5 mortality rate was 6.6 per 100 admissions)

PMR for 5 top diseases among < 5 years, Amana district hospital, (N=1,397)

PMR of other diseases Proportional mortality ratio of other diseases apart from top 5 are; – Malnutrition 5.4% – Septicemia 4.2% – Others (Asthma, Sickle Cell Disease, Congenital Heart Disease, Meningitis, Pulmonary TB, Poison) 5.9%

PMR trend of 5 top diseases among < 5 years, Amana hospital, (N=1,397)

PMR trend of 5 top diseases among infants, Amana hospital, (N=834)

Limitation Cross sectional data Lack of defined hospital based surveillance which could be used as a base for extraction of relevant information Missed information from the existing records Hospital data not representative of general population. However they are relevant in; – Hospital planning – Potential clinical intervention evaluation

Conclusion Pneumonia deaths is a leading cause of death in all years with no significant change Acute watery diarrhea PMR for under-fives decreased HIV/AIDS PMR for under-fives increased Infants and older children had an increase in Malaria PMR, but it was only infant that was significant

Comparison with other developing countries Hospital based < 5 mortality rate was found to be 6.6%. However, overall < 5 mortality rate in Tanzania is 8.1% (TDHS, 2010) This study found found major causes of death to < 5 were pneumonia, malaria, anaemia and HIV/AIDS Other studies from developing countries also showed similar findings – Lagos State, Nigeria {(Rasheed K. O, October 2008), – Burkina Faso (Gaël P Hammer at al 2006) – West Africa (Heiko Becher at al January 2008), – Nigeria (George I. O at al 2009), – West Africa (Robert P Ndugwa at al 2008), – Nairobi, Kenya (Yazoume Ye at al November 2009)}

Public Health Implications High prevalence of deaths attributed to pneumonia calls for an evaluation of -The newly established Pentavalent (DPTHB-Hib) vaccine program -Adequacy of equipments and supplies for case management -Best practice for pneumonia case management Ongoing strategies for malaria management for infants may require revision. Ministry of Health should ensure availability of lab equipments and supplies (MRDT KITS) Potential causes for the increase in HIV/AIDS mortality among under-fives needs to be further explored There is a need of establishment of hospital based electronic surveillance

Acknowledgement Ministry of Health and Social Welfare (MoHSW) Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) Centre for Disease Control and Prevention (CDC)

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