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  • Title: Childhood morbidity and mortality in a large hospital over last four decades.
    Author: Choudhury P, Kumar P, Puri RK, Prajapati NC, Gupta S.
    Journal: Indian Pediatr; 1991 Mar; 28(3):249-54. PubMed ID: 1937700.
    Abstract:
    Pediatric statistics in a 50-year-old large hospital were analysed to find out any change in pediatric admission rate, morbidity and mortality and outcome of common disorders during the last four decades. Information was collected from four block years from each of the last four decades and compared. An increase of almost 250% in the total pediatric admissions as compared to an increase of 150% in total hospital admissions over last four decades suggest an increased awareness of maternal and child health by the community. The pediatric mortality excluding neonates has not shown a significant fall over the last four decades, being 14.6, 12.7 and 13.0% in 1955-1958, 1974-1977 and 1984-1987, respectively. Diarrheal disorders, pneumonia, tetanus and infections of central nervous system continue to remain the common causes of hospital admissions in children. The morbidity and mortality in these disorders, in general, have shown a significant decline though less appreciable in pyogenic meningitis, encephalitis and tetanus cases. An analysis was conducted on the pediatric admissions of children 12 years of age, and morbidity and mortality from Lok Nayak Jai Prakash Narayan Hospital, Delhi, India for the periods of 1955-58, 1965-68, 1974-77, 1984-87. The hospital is attached to a medical school and has a 1980s pediatric bed strength of 150. The population using this facility was low or middle income. Admission for pediatric surgery, orthopedic, ear-nose-throats, or other specialities were not included. Pediatric admissions from the 1st period to the present period increased by 3 times to 31, 187. The total hospital admissions over the 22 years from block periods 1965-1987 only showed a 1.5 times rise in the admission rate. Pediatric admissions were 11.6% , 167.7%, and 18.4% of total hospital admissions for 1965-68, 1974-77, and 1984-87 respectively. When nursery admissions are excluded, admissions were stable at 12%. The commonest cause of admissions was diarrheal disorders, followed by pneumonia. The Indian population consists of a 40% pediatric age group and almost 50% of total mortality occurs in this age group. The increase in pediatric admissions is understood to be reflective of a growing awareness of child health. Pediatric mortality has declined from 15.6% in 1965-68 to 11% in the mid 1970s and 10.8% in 1984-87. When neonatal mortality has been excluded from pediatric mortality, there has also been a decline and stabilization since 1955 at 13.1%. A primary concern is deaths from tetanus. 20.8% in 1974-77 and 13.6% in 1984-87 of neonatal deaths were due to preventable tetanus infections. 60% of the admissions in 1984-87 were for tetanus and resulted in 87.9% of deaths. This hospital center acts as a referral center for tetanus. Epidemics have affected the rates of pyogenic meningitis and encephalitis. Community awareness of disease also affects admissions. Mortality from diarrheal disorders has declined significantly from 19.7% in 1955-58 to 8.2% in 1974-77 and stabilized due to newer diagnostic and treatment procedures such as oral rehydration therapy and public awareness.
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