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Introduction: Global mortality trends have changed over time and are expected to continue changing with a reduction in communicable diseases and an increase of non-communicable disease. Increased survival of children beyond five years may change mortality patterns for these children. There are few studies in Africa that explore the causes of mortality in children over five years. The objective of this study was to determine the mortality rate and clinical profiles of children aged 5-17 years who died in six Kenyan hospitals in 2013. Methods: Retrospective review of patients’ medical records to abstract data on diagnosis for those who died in year 2013. Data was analysed to provide descriptive statistics and explored differences in mortality rates between age groups and gender. Results: We retrieved 4,520 patient records. The in-hospital mortality rate was 3.5% (95%CI 3.0-4.1) with variations in deaths between the ages and gender. Among the deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non-communicable diseases. A further 11.9% succumbed to traumatic injuries. The predominant clinical diagnoses among patients who died were HIV/AIDS, respiratory tract infections and malaria. Conclusion: infectious causes had the highest proportion of diagnoses among children aged 5-17 years who died.
The study was carried out in five government hospitals spread across different regions of Kenya and one private hospital in Nairobi. The five government hospitals were purposively selected because they are the referral hospitals for the counties they serve and represent a wide geographical area within the country. The private hospital was included to provide a perspective of children from a higher socio-economic group. A retrospective hospital based study using admission registers as the sampling frame, for the 2013 calendar year was used to identify all children aged 5-17 years. The study included all children aged 5-17 as the study sample. Hospital records were retrieved, reviewed and data abstracted from patient’s discharge or death summaries for interest variables (age, gender and diagnosis at death). The researcher or trained research assistants reviewed the whole patient record to extract the required data where there were no summaries. Three patients’ records from the private hospital were not available for review due to medico-legal reasons and were excluded from this analysis. In this study, age was categorised into groups (5-9, 10-14 and 15-17 years) as a modification of the age categories used by Lozano [3], Patton [2], Wang [10], and the Kenya Demographic and Heath Survey [16] with the upper age cut-off of 17 years as the legal age cut-off for children. The mortality proportion was calculated as all the deaths in the age group divided by the age group total admissions, expressed as a percentage to describe the mortality pattern. Pearson’s chi-square test and odds ratios were calculated to explore differences in deaths between genders, age groups and HIV status at 95% confidence interval. The patients’ diagnoses were categorised in accordance with the Lozano [3] study classifications and to allow for comparison. The disease classification used was based on the study by Lozano, et al on global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010; a systematic analysis for the Global Burden of Disease (GBD) Study [3] as shown in Table 1. This classification was chosen to make comparison of findings with other international studies easier. However, many patients had multiple diagnoses with some appearing across disease classification categories and hence some patients fell in more than one disease category. Patients with injuries did not have full details on where it occurred, the cause, nature and type of injury and were therefore grouped together as injuries. We obtained approval from the Human Research Ethics Committee at the Faculty of Health Sciences, University of Cape Town (UCT) and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH-UoN ERC). Hospital review boards and administration permission were obtained from all the hospitals where the study was conducted. Patient confidentiality was maintained at all times. Names of the patients/study participants were not collected by the study. Once the hospital number was noted, it was de-identified by giving it a code that could not be traced back to the patients. Only coded data was transported to conceal identities. In addition, the data was stored in files kept under lock and key with restricted access in secured offices. Electronic databases were encrypted and stored in password-protected, secure computers. Classification of diseases as adopted from Lozano et al. (2010). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010; a systematic analysis for the GBD Study [3]
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