Introduction
Methodology
Study area characteristics
Study site
Study design
Research problem
Research question
Boundary of the study
Ethics committee approval
Data collection
Data analysis
Results
General characteristics of study children
ALL | By gender | By age (years) | |||||
---|---|---|---|---|---|---|---|
Male | Female | 1-1.9 | 2-2.9 | 3-3.9 | 4-4.9 | ||
Number | 301 | 173 | 128 | 148 | 73 | 55 | 25 |
% | 57.5 | 42.5 | 49.2 | 24.3 | 18.3 | 8.3 | |
-Male | - | - | - | 89 | 42 | 31 | 11 |
-% | - | - | - | 51.4 | 24.3 | 17.9 | 6.4 |
-Female | - | - | - | 59 | 31 | 24 | 14 |
-% | - | - | - | 43.1 | 24.2 | 18.8 | 10.9 |
χ2=2.31, df=3, p=0.51 | |||||||
Age (year) | |||||||
-Mean | 2.1 | 2.0 | 2.1 | 1.2 | 2.2 | 3.2 | 4.1 |
-±SEM | 0.06 | 1.0 | 1.0 | 0.02 | 0.03 | 0.03 | 0.03 |
-Min. | 1.0 | 1.0 | 1.0 | 1.0 | 2.0 | 3.0 | 4.0 |
-Max. | 4.5 | 4.5 | 4.0 | 1.9 | 2.8 | 3.5 | 4.5 |
F-statistics=1512.90, p=0.000 | |||||||
Weight (kg) | |||||||
-Mean | 10.0 | 10.2 | 9.8 | 7.9 | 10.3 | 12.5 | 14.8 |
-±SEM | 3.7 | 4.2 | 2.9 | 0.16 | 0.26 | 0.29 | 0.61 |
-Min. | 2.5 | 2.5 | 3.8 | 3.1 | 2.5 | 5.2 | 7.5 |
-Max. | 39.8 | 39.8 | 18.7 | 15.0 | 15.0 | 17.0 | 20.0 |
F-statistics=115.04, p=0.000 | |||||||
Temperature °C | |||||||
-Mean | 37.2 | 37.2 | 37.2 | 37.2 | 37.3 | 37.1 | 37.2 |
-±SEM | 0.05 | 0.8 | 0.9 | 0.07 | 0.10 | 0.10 | 0.13 |
-Min. | 35.0 | 35.0 | 35.2 | 35.0 | 36.0 | 36.0 | 36.0 |
-Max. | 40.2 | 40.2 | 39.6 | 39.8 | 40.2 | 39.6 | 39.0 |
F-statistics=0.319, p=0.811 |
Presenting complaints in the ICU
Age (years) | |||||
---|---|---|---|---|---|
1.0 – 1.9 | 2.0 – 2.9 | 3.0 – 3.9 | 4.0 – 4.9 | ||
(n=148) | (n=73) | (n=55) | (n=25) | ||
No. (%)
|
No. (%)
|
No. (%)
|
No. (%)
|
Total (%)
| |
Common complaints (n=667)
|
354 (53.1)
|
152 (22.8)
|
111 (16.6)
|
50 (7.5)
|
667 (100)
|
- Gastrointestinal system | 108 (62)*! | 31* | 21! | 13 | 173 (25.9) |
- Respiratory system | 73 (53) | 42 | 18 | 5 | 138 (20.7) |
- Dermatological system | 16 (53) | 7 | 3 | 4 | 30 (4.5) |
- Eye, Ear, Nose and Throat | 6 | 1 | 0 | 2 | 9 (1.3) |
- Nervous system | 23 (39)**!! | 18** | 14!! | 4 | 59 (8.8) |
- Renal system | 2 | 1 | 2 | 1 | 6 (0.9) |
- Hematological system | 6 | 0 | 2 | 1 | 9 (1.3) |
- Musculo-skeletal system | 5 | 1 | 6 | 4 | 6 (2.4) |
- Fever | 99 (51) | 45 | 38 | 14 | 196 (29.4) |
- Others | 16 | 6 | 7 | 2 | 31 (4.6) |
Common investigations (n=708)
|
359 (50.7)
|
166 (22.4)
|
130 (18.4)
|
53 (7.5)
|
708 (100)
|
- Full blood count | 111 | 50 | 37 | 17 | 215 (30.4) |
- Malaria parasite | 89 | 36 | 32 | 9 | 166 (23.4) |
- Chest x-ray | 36 | 11 | 6 | 0 | 53 (7.5) |
- ESR | 35 | 9 | 11 | 9 | 64 (9.0) |
- Electrolyte/urea/creatinine | 23 | 15 | 9 | 3 | 50 (7.1) |
-Cerebrospinal fluid | 15 | 8 | 3 | 3 | 29 (4.1) |
-PCV | 9 | 20 | 19 | 8 | 56 (7.9) |
- WBC/Differentials | 8 | 1 | 2 | 0 | 11 (1.6) |
- Grouping/cross-matching | 6 | 5 | 3 | 1 | 15 (2.1) |
- Urinalysis/MCS | 3 | 3 | 1 | 0 | 7 (1.0) |
- Others | 24 | 8 | 7 | 3 | 42 (5.9) |
Clinicians’ diagnoses
Age (years) | Total (%) | ||||
---|---|---|---|---|---|
1.0 – 1.9 | 2.0 – 2.9 | 3.0 – 3.9 | 4.0 – 4.9 | ||
(n = 148) | (n = 73) | (n = 55) | (n = 25) | ||
No. (%)
|
No. (%)
|
No. (%)
|
No. (%)
| ||
Diagnosis (n=587)
|
317
|
137
|
92
|
41
|
587 (100)
|
Nutritional | 19 | 3 | 0 | 0 | 23 (3.9) |
Respiratory | 57 | 26 | 16 | 2 | 101(17.2) |
Cardiac | 17 | 4 | 3 | 1 | 25 (4.3) |
Dermatological | 3 | 0 | 0 | 0 | 3 (0.5) |
Nervous | 16 | 13 | 9 | 5 | 43 (7.3) |
Hematological | 44 | 33 | 26 | 6 | 109 (18.6) |
Hepatic | 0 | 1 | 0 | 1 | 2 (0.3) |
Renal | 2 | 1 | 2 | 1 | 6 (1.0) |
Gastrointestinal | 36 | 3 | 0 | 3 | 42 (7.2) |
Musculo-skeletal | 4 | 0 | 0 | 2 | 6 (1.0) |
Endocrine | 2 | 0 | 0 | 1 | 3 (0.5) |
Inflammatory | 2 | 1 | 0 | 0 | 3 (0.5) |
Dehydration | 27 | 2 | 0 | 1 | 30 (5.1) |
Fever of undetermined origin | 1 | 0 | 0 | 0 | 1 (0.2) |
Infection | 76 | 47 | 41 | 17 | 181 (30.8) |
- Malaria | 46 | 35 | 36 | 14 | 131 (72.4) |
- Measles | 29 | 11 | 3 | 2 | 45 (24.9) |
- Typhoid | 0 | 0 | 1 | 0 | 1 (0.6) |
- Cholera | 1 | 0 | 1 | 0 | 1 (0.6) |
- Tetanus | 0 | 1 | 0 | 1 | 2 (1.1) |
Others | 11 | 3 | 4 | 1 | 19 (3.2) |
Age group (years) | |||||
---|---|---|---|---|---|
1.0 – 1.9 | 2.0 – 2.9 | 3.0 – 3.9 | 4.0 – 4.9 | Total | |
(n=148) | (n=73) | (n=55) | (n=25) | (n=301) | |
Died
|
No. (%)
|
No. (%)
|
No. (%)
|
No. (%)
|
No. (%)
|
31 (20.9)
|
14 (19.2)
|
10 (18.2)
|
4 (16.0)
|
59 (18.3)
| |
- male | 22 (70.9) | 9 (64.3) | 7 (70.0) | 1 (25.0) | 39 (66.1) |
- female | 9 (19.1) | 5 (35.7) | 3 (30.0) | 3 (75.0) | 20 (33.9) |
Presentation at ICU
| |||||
-Male | |||||
○ Gastrointestinal | 16 (73) | 0 (0) | 1 (14) | 0 (0) | 17 (43.6) |
○ Respiratory* | 7 (32) | 7 (78) | 1 (14) | 0 (0) | 15 (38.5) |
○ Nervous system | 3 (14) | 3 (33) | 3 (43) | 0 (0) | 9 (23.1) |
○ Dermatological system | 2 (9) | 1 (11) | 0 (0) | 0 (0) | 3 (7.7) |
○ Eye, Ear, Nose and Throat | 2 (9) | 0 (0) | 0 (0) | 0 (0) | 2 (5.1) |
○ Fever | 8 (36) | 7 (78) | 6 (86) | 1 (100) | 22 (56.4) |
○ Nutritional | 3 (14) | 0 (0) | 3 (43) | 1 (100) | 7 (17.9) |
- Female | |||||
○ Gastrointestinal | 4 (44) | 2 (40) | 0 (0) | 1 (33) | 7 (35.0) |
○ Respiratory* | 7 (78) | 3 (60) | 2 (67) | 3 (100) | 15 (75.0) |
○ Nervous system | 4 (44) | 1 (20) | 1 (33) | 0 (0) | 6 (30.0) |
○ Dermatological system | 0 (0) | 1 (20) | 0 (0) | 2 (67) | 3 (15.0) |
○ Eye, Ear, Nose and Throat | 0 (0) | 0 (0) | 1 (33) | 1 (33) | 2 (10.0) |
○ Fever | 4 (44) | 3 (60) | 1 (33) | 2 (67) | 10 (50.0) |
○ Nutritional | 0 (0) | 1 (20) | 0 (0) | 1 (33) | 2 (10.0) |
*Chi-square test of significance in proportion that presented with respiratory symptom in males and in females: OR = 0.21 (0.05-0.79); χ²=7.1; p=0.008: | |||||
Diagnosis at ICU
| |||||
- Male | |||||
○ Dehydration | 8 (36) | 1 (11) | 0 (0) | 0 (0) | 9 (23.1) |
○ Gastrointestinal | 7 (32) | 0 (0) | 0 (0) | 0 (0) | 7 (17.9) |
○ Respiratory | 7 (32) | 4 (44) | 4 (57) | 0 (0) | 15 (38.5) |
○ Nutritional | 5 (23) | 1 (11) | 0 (0) | 0 (0) | 6 (15.4) |
○ Hematological | 5 (23) | 1 (11) | 2 (29) | 1 (100) | 10 (25.6) |
○ Nervous system | 4 (18) | 2 (22) | 1 (14) | 0 (0) | 7 (17.9) |
○ Cardiac system | 2 (9) | 2 (22) | 1 (14) | 0 (0) | 5 (12.8) |
○ Dermatological | 2 (9) | 0 (0) | 0 (0) | 0 (0) | 2 (5.1) |
○ Hepatic system | 0 (0) | 0 (0) | 0 (0) | 1 (100) | 1 (2.6) |
○ Renal system | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
○ Infection | |||||
Malaria | 6 (27) | 2 (22) | 5 (71) | 1 (100) | 14 (35.9) |
Measles | 5 (23) | 1 (11) | 1 (14) | 0 (0) | 7 (17.9) |
- Female | |||||
○ Dehydration | 1 (11) | 0 (0) | 0 (0) | 0 (0) | 1 (5.0) |
○ Gastrointestinal | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
○ Respiratory | 5 (56) | 1 (20) | 2 (67) | 1 (33) | 9 (45.0) |
○ Nutritional | 2 (22) | 2 (40) | 0 (0) | 0 (0) | 4 (20.0) |
○ Hematological | 2 (22) | 2 (40) | 0 (0) | 0 (0) | 4 (20.0) |
○ Nervous system | 3 (33) | 2 (40) | 1 (33) | 2 (67) | 8 (40.0) |
○ Cardiac | 0 (0) | 0 (0) | 1 (33) | 0 (0) | 1 (5.0) |
○ Dermatological | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
○ Hepatic system | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
○ Renal system | 0 (0) | 1 (20) | 0 (0) | 0 (0) | 1 (5.0) |
○ Infection | |||||
Malaria | 4 (44) | 3 (60) | 1 (33) | 2 (67) | 10 (50.0) |
Measles | 3 (33) | 2 (40) | 0 (0) | 2 (67) | 7 (35.0) |
Mean weight of children that died in ICU by age group, gender and weight group (Table 5)
Age group (years) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1-1.9 | 2-2.9 | 3-3.9 | 4-4.9 | Total | ||||||
Dchd. | Died | Dchd. | Died | Dchd. | Died | Dchd. | Died | Dchd. | Died | |
Number | 90 | 31 | 52 | 14 | 40 | 10 | 19 | 4 | 20 | 59 |
Mean wt. (kg) | 8.2 | 7.0 | 10.3 | 9.6 | 13.0 | 11.2 | 15.1 | 13.6 | 10.4 | 8.7 |
±SEM | 0.2 | 0.3 | 0.3 | 0.8 | 0.3 | 0.9 | 0.5 | 3.1 | 0.2 | 0.4 |
Min. | 4.0 | 3.8 | 5.9 | 2.5 | 9.6 | 5.2 | 11.6 | 7.5 | 4.0 | 2.5 |
Max. | 15.0 | 11.0 | 14.0 | 14.0 | 17.0 | 19.0 | 20.0 | 19.0 | 20.0 | 19.0 |
df | 56.1 | 15.7 | 11.3 | 3.2 | 87.4 | |||||
t | 3.4 | 0.8 | 1.9 | 0.5 | 3.3 | |||||
p | 0.001 | 0.43 | 0.09 | 0.65 | 0.002 | |||||
Male children in ICU
| ||||||||||
Number | 51 | 22 | 30 | 9 | 23 | 7 | 9 | 1 | 113 | 39 |
Mean | 8.4 | 7.0 | 10.9 | 9.2 | 13.1 | 10.5 | 16.0 | 10.5 | 10.6 | 8.4 |
±SEM | 0.3 | 0.4 | 0.4 | 1.2 | 0.4 | 1.1 | 0.9 | - | 0.3 | 0.5 |
Min. | 4.1 | 4.3 | 5.9 | 2.5 | 10.0 | 4.1 | 11.6 | 5.2 | 4.1 | 2.5 |
Max. | 15.0 | 11.0 | 14.0 | 14.0 | 17.0 | 20.0 | 20.0 | 14.0 | 20.0 | 19.0 |
df | 46.36 | 9.41 | 7.64 | - | 63.0 | |||||
t | 3.3 | 1.4 | 2.1 | - | 3.7 | |||||
p | 0.002 | 0.20 | 0.07 | - | 0.001 | |||||
Female children in ICU
| ||||||||||
Number | 39 | 9 | 22 | 5 | 17 | 3 | 10 | 3 | 88 | 20 |
Mean | 7.9 | 7.0 | 9.5 | 10.4 | 12.5 | 12.9 | 14.2 | 11.1 | 9.9 | 9.3 |
±SEM | 0.3 | 0.5 | 0.3 | 0.8 | 0.4 | 0.6 | 0.5 | 2.9 | 0.3 | 0.7 |
Min. | 4.0 | 3.8 | 6.5 | 8.5 | 9.5 | 12.0 | 12.0 | 7.5 | 4.0 | 3.8 |
Max. | 12.0 | 8.5 | 11.0 | 12.4 | 16.0 | 14.0 | 17.5 | 16.7 | 17.5 | 16.7 |
df | 12.5 | 4.9 | 4.3 | 2.1 | 26.3 | |||||
t | 1.7 | -1.1 | -0.4 | 1.1 | 0.8 | |||||
p | 0.12 | 0.33 | 0.67 | 0.38 | 0.44 |
Prognostic values of children in ICU (Table 6)
Discharged | Died | |||||||
---|---|---|---|---|---|---|---|---|
Age group (years) | Age group (years) | |||||||
1-1.9 | 2-2.9 | 3-3.9 | 4-4.9 | 1-1.9 | 2-2.9 | 3-3.9 | 4-4.9 | |
Prognosis
|
All studied children
| |||||||
-Good | 0 (0) | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
-Fair | 3 (3) | 3 (6) | 0 (0) | 2 (11) | 0 (0) | 1 (7) | 0 (0) | 0 (0) |
-Poor | 41 (46) | 24 (46) | 17 (42) | 11 (58) | 5 (16) | 1 (7) | 2 (20) | 3 (75) |
-Very poor | 45 (50) | 25 (48) | 22 (55) | 6 (32) | 25 (81) | 12 (86) | 8 (80) | 1 (25) |
-Extremely poor | 1 (1) | 0 (0) | 0 (0) | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) |
Male children admitted into ICU
| ||||||||
-Fair | 0 (0) | 1 (7) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (7) | 0 (0) |
-Poor | 5 (16) | 1 (7) | 2 (20) | 3 (75) | 2 (50) | 5 (13) | 2 (13) | 1 (50) |
-Very poor | 25 (80) | 12 (86) | 8 (80) | 1 (25) | 2 (50) | 32 (84) | 12 (80) | 1 (50) |
-Extremely poor | 1 (4) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (3) | 0 (0) | 0 (0) |
Female children admitted into ICU
| ||||||||
-Fair | 0 (0) | 1 (11) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (11) | 0 (0) |
-Poor | 4 (18) | 1 (11) | 2 (29) | 0 (0) | 1 (33) | 4 (15) | 2 (22) | 0 (0) |
-Very poor | 17 (77) | 7 (78) | 5 (71) | 1 (100) | 2 (64) | 21 (81) | 6 (67) | 1 (100) |
-Extremely poor | 1 (5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 0 (0) |
Outcome of admission into ICU
Age group (years) | ||||
---|---|---|---|---|
1-1.9 | 2-2.9 | 3-3.9 | 4-4.9 | |
Outcome
| (n=148) | (n=73) | (n=55) | (n=25) |
All children
admitted into
ICU
| ||||
- Fully recovered and discharged* | 90 (61) | 52 (71) | 40 (73) | 19 (76) |
- Absconded | 6 (4) | 1 (1) | 0 (0) | 0 (0) |
- Referred | 3 (2) | 2 (3) | 0 (0) | 0 (0) |
- DAMA | 12 (8) | 2 (3) | 3 (5) | 1 (4) |
- On admission | 6 (4) | 2 (3) | 2 (4) | 1 (4) |
- Died* | 31 (21) | 14 (19) | 10 (18) | 4 (16) |
Odds ratio | 1.37 | 0.89 | 0.82 | 0.70 |
CI | 0.7-2.5 | 0.4-1.8 | 0.4-1.9 | 0.2-1.9 |
Male children
admitted into
ICU
| ||||
(n=89) | (n=42) | (n=31) | (n=11) | |
- Fully recovered and discharged* | 51 (57) | 30 (71) | 23 (74) | 9 (82) |
- Absconded | 3 (3) | 1 (2) | 0 (0) | 0 (0) |
- Referred | 2 (2) | 0 (0) | 0 (0) | 0 (0) |
- DAMA | 6 (7) | 0 (3) | 0 (0) | 0 (0) |
- On admission | 5 (6) | 2 (5) | 1 (3) | 1 (9) |
- Died* | 22 (25) | 9 (21) | 7 (19) | 1 (9) |
Odds ratio | 1.57 | 0.83 | 0.86 | 0.30 |
CI | 0.7-3.5 | 0.3-2.1 | 0.3-2.4 | 0.01-2.5 |
Female children
admitted into
ICU
| ||||
(n=59) | (n=31) | (n=24) | (n=14) | |
- Fully recovered and discharged | 39 (66) | 22 (71) | 17 (71) | 10 (71) |
- Absconded | 3 (5) | 0 (0) | 0 (0) | 0 (0) |
- Referred | 1 (2) | 2 (6) | 0 (0) | 0 (0) |
- DAMA | 6 (10) | 2 (6) | 3 (13) | 1 (7) |
- On admission | 1 (2) | 0 (0) | 1 (4) | 0 (0) |
- Died | 9 (15) | 5 (16) | 3 (13) | 3 (22) |
Odds ratio | 1.0 | 1.0 | 0.74 | 1.4 |
CI | 0.4-3.0 | 0.3-3.4 | 0.2-3.1 | 0.3-6.3 |
Patient's age | Patient's gender | Patient's weight (kg) | Patient's temperature | 1st diagnosis | Age group | |||
---|---|---|---|---|---|---|---|---|
Patient’s age | 1 | .064 | .727 | -.027 | .116* | -.109 | -.058 | .969** |
.272 | .000 | .636 | .045 | .058 | .318 | .000 | ||
301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 | |
Patient’s gender | .064 | 1 | -.041 | .042 | -.020 | -.007 | -.078 | .076 |
Sig. (2-tailed) | .272 | .484 | .463 | .727 | .902 | .179 | .186 | |
N | 301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 |
Patient’s weight (kg) | .727 | -.041 | 1 | -.025 | .132* | -.143 | -.195 | .721** |
.000 | .484 | .669 | .022 | 0.13 | .001 | .000 | ||
301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 | |
Patient’s temperature | -.027 | .042 | -.025 | 1 | -.070 | -.098 | -.042 | -.016 |
.636 | .463 | .669 | .223 | .090 | .463 | .779 | ||
301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 | |
1st diagnosis | .116 | -.020 | .132 | -.070 | 1 | -.066 | .028 | .121* |
Sig. (2-tailed) | .045 | .727 | .022 | .223 | .257 | .631 | .036 | |
N | 301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 |
Prognosis | -.109 | -.007 | -.143 | -.098 | -.066 | 1 | .196 | -.102 |
.058 | .902 | .013 | .090 | .257 | .001 | .079 | ||
301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 | |
Outcome | -.058 | -.078 | -.195 | -.042 | .028 | .196 | 1 | -.075 |
Sig. (2-tailed) | .318 | .179 | .001 | .463 | .631 | .001 | .194 | |
N | 301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 |
Age group | .969 | .076 | .721 | -.016 | .121* | -.102 | -.075 | 1 |
.000 | .186 | .000 | .779 | .036 | .079 | .194 | ||
N | 301 | 301 | 301 | 301 | 301 | 301 | 301 | 301 |