185923 USE of Child Healthcare Problem Identification Programme (CHILD PIP) Data to Inform and Promote Pathway to Child Survival

Wednesday, October 29, 2008

Shuaib Kauchali, FCPaed, MPhil , Epidemiology, Columbia University, Durban 4062, NY, South Africa
Introduction: Child healthcare problem identification programme (Child PIP) is used as a reliable monitoring and evaluation tool to improve quality of care of hospitalized children in South Africa. Quality of pre-hospital care at home, or at clinics, or during emergency transportation all influence in-hospital mortality rates.

Aim: to demonstrate the utility of hospital admission and mortality data to assess the adequacy of pre-hospital healthcare among children aged < 5 years within a health district.

Study design: period-based cross-sectional study.

Methods: We analysed total admissions, characteristics of admissions and deaths, all-cause, cause- and age-specific in-hospital mortality rates (IHMR) among children < 5 years from 8 participating hospitals from all levels of care (district, regional and tertiary) in KwaZulu-Natal in 2006.

Results: Of all admissions < 5 years (N=8621), 62% were infants, 63% were malnourished, and an estimated 70% were either infected or suspected HIV. All-cause IHMR was 9.2 per 100 admissions (range: 6.5-10.8), with highest rates among infants. Cause-specific IHMR were: 23.9 for severe malnutrition, 14.9 for weight < 3rd centile, 11.0 for respiratory infections, and 9.0 for diarrheal diseases. More than 2/3rd of all deaths occurred within 72 hours of admission. At least 67% of all preventable causes of in-hospital deaths were identified as being outside the hospital (Home, Clinic, and Accident & Emergency).

Interpretation: Despite hospital mortality statistics being inherently biased toward children who were either very ill or those who had access to facility level healthcare, Child PIP data may be used as sentinel indices for monitoring and evaluating pre-hospital child health programmes, such as IMCI, PMTCT of HIV, Nutrition and emergency care, to close the loop on the pathways to child survival at the district level.

Source of funding: Center for Disease Control & Prevention (CDC, Atlanta) and South African Medical Research Council (MRC)

[Word Count: 279]

Learning Objectives:
1. Understand the care South African children receive in the District Health System; 2. Learn about a simple reliable mortality auditing tool to systematically assess causes of death among children in the South African Health System, 3. Identify major causes of death among children in South African Health System, 4. Identify modifiable factors that contributed to death among children in SA Health System 5. Appreciate how facility-based data can inform about broader epidemiological indices of child health, such as infant mortality rate.

Keywords: International Public Health, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am author and Child PIP member and coordinator
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: IH Poster Session 7: Health Policy & Access
See more of: International Health