Abstract

Assessing Predictors of Mortality Among Children admitted with Sepsis at a Referral Tertiary Health Center, Northwestern Nigeria: Need for Review of Sepsis Management Protocol.

Baffa Sule Ibrahim, MD, MPH. MSC¹, Fatima Hassan-Hanga, MBBS, FMCP², Hafsat Ibrahim, MBBS, FMCP², Halima Kabir, MBBS, FMCP², Kabiru Abdulsalam, MBBS, FMCP², Zainab Datti Ahmed, MBBS, MRH, FWACS², Halima Salisu Kabara², Dalha Haliru Gwarzo, MBBS, FMCP², Abdullahi Sule Gaya, MBBS, FWACS², Nasiru Magaji Sadiq² (1)Maryland Global Initiative Corporation , an affiliate of the University of Maryland Baltimore (UMB), (2)Aminu Kano Teaching Hospital, Kano

APHA 2022 Annual Meeting and Expo

Introduction: Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death. We aim to assess predictors of mortality among children admitted with Septicemia at a referral tertiary health facility in Northwestern Nigeria.
Methods: We conducted a prospective cross-sectional study of children aged 0-14 years admitted to various units of pediatrics department of the health facilities. Children were recruited between September 2018 and November 2019. All recruited children were followed up on clinical progress until either discharge, abscondment or death. We assessed all children clinically daily, and collected whole-blood, samples for laboratory tests. We conducted univariate and multivariate analysis using STATA-16 to assess identified predictive factors with our outcome variable.
Results: A total of 326 children were recruited, median age: 2-years, and range: 0-14 years. About 54.0% of the children were boys, and 53.1% were within 1-5 years age-group, while 27.0% were under one-year. Predominant organisms cultured from the blood of the children were Salmonella typhi (5.7%), Klebsiella pneumoniae (2.3%), and Staphylococcus aureus (2.0%). A total of 35 deaths were recorded with case fatality rate (CFR) of 10.7%. CFR is highest in children <1years (13.6%).
Child’s vaccination status, mother’s education level as well as blood lactate levels, GCS, qSOFA score and positive blood culture were significantly associated with child’s mortality. Factors associated with increase mortality include; children with incomplete vaccination history [OR=1.72, 95%CI: 2.74–15.53] versus those with full vaccination; children whose mothers had no formal education [OR=14.39, 95%CI: 3.24–63.99] when compared to those children whose mothers have tertiary level of education. Furthermore, children with whole blood lactate level between 4-8mmol/l [OR=3.23, 95%CI: 1.15–9.07], or greater than 8mmol/l [OR=10.54, 95%CI: 3.68–30.14] versus children with whole blood lactate level less than 4mmol/l; children with qSOFA score of 3 [OR=15.62, 95%CI: 3.31–73.60] versus children with qSOFA score of 1; and children who have a positive blood culture [OR=6.90, 95%CI: 3.04–15.64]. A GCS between 14-15 (mild) at enrollment is associated with improved survival [OR=0.19, 95%CI: 0.08–0.45] when compared to children with GCS of 3-8 (severe) at enrollment.
Conclusion: We found a high prevalence of severe sepsis at pediatrics department of AKTH. Serum lactate levels, GCS, and qSOFA scores were predictive of mortality. Routine measurement and monitoring of these parameters will improve case management and reduce sepsis related mortality in the hospital.