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Under Five Mortality Patterns in an Urban Area: A Hospital Based Study in Dar es Salaam Tanzania (2008-2010). 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

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  1. Under Five Mortality Patterns in an Urban Area: A Hospital Based Study in Dar es Salaam Tanzania (2008-2010) Kishimba R, Mohamed I1, Mohamed MA1,2,Mghamba JM1,2, Simba A1,2, Ngware Z1,2 , Senga S1,2, Mmbuji P1,2 1. Field Epidemiology and Laboratory Training Program, Tanzania 2. Ministry of Health and Social Welfare

  2. 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

  3. 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

  4. 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

  5. Study Design and Data Collection • Cross sectional study • Study area: Amana Municipal Hospital • Review of pediatric in-patient death registers, 2008-2010. • Information abstracted: age, sex, place of domicile, year of death, and primary cause of death

  6. 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

  7. Medical Records, Amana Hospital

  8. Results • Between 2008-2010: • 21,085 under-five were admitted • 1,397 under-five died(Overall <5 mortality rate was 6.6 per 100 admissions)

  9. PMR for 5 top diseases among < 5 years, Amana district hospital, 2008-2010 (N=1,397)

  10. 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%

  11. PMR trend of 5 top diseases among < 5 years, Amana hospital, 2008-2010 (N=1,397)

  12. PMR trend of 5 top diseases among infants, Amana hospital, 2008-2010 (N=834)

  13. 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

  14. 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

  15. 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)}

  16. 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

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

  18. THANK YOU FOR YOUR ATTENTION

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