FACTORS INFLUENCING MORTALITY PATTERN AMONG UNDER-FIVE CHILDREN ADMITTED IN SELECTED STATE AND MISSION HOSPITALS IN IBADAN, NIGERIA

Abstract

Overall Under-Five Mortality Rate (U5MR) is reportedly high in Nigeria. Statistics on U5MR in Nigeria are mainly derived from data obtained from community-based surveys and teaching hospital records. There are few reports on childhood mortality from secondary health institutions where many deaths are known to occur. This study was therefore designed to determine the mortality pattern and factors influencing mortality among under-five children admitted in selected hospitals in Ibadan. A review of records of deaths and admissions occurring in under-five children between January 2005 and December 2009 was conducted in three purposively selected mission and state hospitals in Ibadan. A total of 19,203 under-five children were admitted within the period under review. Records of all the 2146 under-five children that died and an equal number of children admitted but recovered which were matched for age and sex were reviewed using a structured chart review form. Information collected included age, place of residence, parents’ occupation and causes of death. Data were analyzed using descriptive statistics, Chi-square test and logistic regression at P<0.05. Results were compared with the World Health Organisation mortality rate standard of < 40/1000 admission. The mean ages for neonates, post-neonates and children aged 12-59 months were 8.5 ± 5.5 days, 6.1 ± 3.1 months and 26.4 ± 13.1 months respectively. Many of the deaths (47.4%) occurred within 24 hours of hospitalisation. Overall U5MR was 111.8/1000 admissions. Annual trend in mortality rate was 107.6/1000 in year 2005, 95.7/1000 in 2006, 96.5/1000 in 2007, 127.1/1000 in 2008 and 128.7/1000 in 2009. Mortality rate per 1000 admissions was highest (132.3/1000) among post-neonates, followed by neonates (88.2/1000) and children aged 12-59 months (52.5/1000). Neonatal deaths were mainly due to sepsis (32.2%), perinatal asphyxia (26.5%), prematurity (14.4%), and meconium aspiration syndrome (4.5%). Malaria (25.7%) was the predominant cause of death among post-neonates followed by bronchopneumonia (16.3%), gastroenteritis (12.4%), sepsis (10.1%) and anaemia (5.9%). Malaria (35.2%), anaemia (11.2%), measles and post measles complications (10.8%), gastroenteritis (7.8%) and bronchopneumonia (6.6%) were the main causes of deaths among 12-59 months. Immunisation history was significantly associated with mortality (p<0.05). Children from highly congested areas (81.9%) were 2 times more likely to die compared with children from the suburban areas (OR = 2.0, 95% CI = 1.5, 2.7). U5MR was significantly more among children whose father were engaged in unskilled works (OR=2.0, 95% CI=0.3, 0.7). Children were at higher risk of dying during rainy season than in the dry season (OR=2.3, 95% CI=0.5, 0.8). Under-five mortality rate was higher than the World Health Organisation standard over the five year review period and the deaths were mostly caused by infections and preventable conditions. Advocacy and public enlightenment for the adoption of immunisation services and timely presentation to hospitals are needed to reduce the prevalence of under-five mortality.