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  • Title: Clinical analysis of mortality in hospitalized Zambian children with sickle cell anaemia.
    Author: Athale UH, Chintu C.
    Journal: East Afr Med J; 1994 Jun; 71(6):388-91. PubMed ID: 7835262.
    Abstract:
    The hospital records of 62 Zambian children with sickle cell anaemia (SCA) who died during a 3 year period (January 1987 to December 1989) at the Paediatric Wing of the University Teaching Hospital, Lusaka, Zambia, were reviewed retrospectively. The SCA patients accounted for 2.92 percent of the total admissions and the average case fatality was 6.61 percent of the total SCA admissions. The case fatality rate has reduced considerably as compared to the one observed in 1970 in Zambia, although the major causes of death remain the same. The maximum mortality was noted in the age group of one to five years (54.84%). The common causes of death were infections (29.54%), vasoocclusive crises (22.72%) and splenic sequestration crises (20.45%). The problems of sub-Saharan Africa, like malaria, malnutrition and now the HIV infection also adde to the mortality (15.90%). Physicians analyzed the hospital records of 62 sickle cell anemia (SCA) patients who were admitted to the pediatric wing of the University Teaching Hospital in Lusaka, Zambia, between January 1987 and December 1989 and who died. They examined the case fatality rate and the causes of death. During this period, SCA patients comprised 938 of the 31,843 pediatric admissions (2.95%). The case fatality rate of these 938 urban SCA patients was 6.61%, which is much lower than the 1970 rate of 18.57%. The researchers attributed the lower case fatality rate to the comprehensive health care provided by the hospital's sickle cell disease clinic, established in 1971. Sickle cell-related deaths during the study period made up 0.97% of all pediatric deaths. The case fatality rate was 20.17% for all pediatric admissions. SCA-related mortality peaked in the 1-5 year old age group (38.71%) followed by the 6-10 year old age group (20.97%). As for causes of death, the case records of only 44 sickle cell-related deaths were available. The pediatricians were not able to specify the exact clinical diagnosis in 18 case files (29.03%). The major categories of causes of death were infections (29.54%), vaso-occlusive crises (22.72%), and splenic sequestration crises (20.45%). The infections included 6 cases of bronchopneumonia, 4 cases of confirmed malaria, 1 case of pneumococcal meningitis, and 1 case of HIV infection with cardiomyopathy. The researchers were not sure whether the HIV infection or SCA caused cardiomyopathy. An earlier study at the hospital found HIV seroconversion in more and more SCA patients. This study's major obstacles were poor record keeping, poor communication channels, inability to conduct autopsies due to social and cultural reasons, procedural delays, and unavailability of pathologists. These obstacles must be addressed to improve knowledge on death in SCA patients.
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