Mortality within 24 hours of admission to the Paediatric Unit, Harare Central Hospital, Zimbabwe.

Objective: To determine the proportion of deaths, characteristics of children and risk factors for mortality w ithin 24 hours of admission to a Paediatric hospital in Harare.

Study design: Prospective cohort study.

Settings: Paediatric Unit, Harare Central Hospital.

Subjects: All patients admitted to the medical wards who consented to participate were enrolled. Preadmission factors including duration of illness and health seeking behaviour prior to presentation, delays in A&E department assessed by lag time to assessment, administration of initial medications and admission to the ward were documented. The presenting clinical signs and admission diagnoses were also recorded

Main outcome measure: Death within 24 hours of admission.

Results: Of the 737 paediatric admissions during the study period, 54 children died within 24 hours giving a case fatality rate of 7.3%. These constituted 34.6% of total deaths in the study population (54/155). The median age of the children in this study was 16 months (Q1 = 4, Q3 = 36) and 53.2% were male. Having subcostal recessions on admission was significantly associated with mortality (within 24 hours of admission) with a RR 29.9 (95% CI 1.56.74) while socio-demographic factors, duration of illness, fever, diagnosis on admission and delays in A & E department were not.

Conclusion: The contribution of deaths within 24 hours of admission to the overall mortality in children remains unacceptably high. Sub-costal recessions on admission (a proxy for severe pneumonia) had the highest risk of mortality within 24 hours of admission. There is need for early identification and aggressive management of children with pneumonia.