Epidemiology of Disease and Mortality From a PICU in Mozambique

Objectives: Delivery of pediatric critical care in low-income countries is limited by a lack of infrastructure, resources, and providers. Few studies have analyzed the epidemiology of disease associated with a PICU in a low-income country. The aim of this study was to document the primary diagnoses and the associated mortality rates of patients presenting to a tertiary PICU in Mozambique in order to formulate quality improvement projects through an international academic partnership. We hypothesized that the PICU mortality rate would be high and that sepsis would be a common cause of death. Design: Retrospective, observational study. Setting: Tertiary academic PICU. Patients: All admitted PICU patients. Interventions: All available data collection forms containing demographic and clinical data of patients admitted to the PICU at Hospital Central de Maputo, Mozambique from January 2013 to December 2013 were analyzed retrospectively. Measurements and Main Results: The patient median age was 2 years (57% male). The most common primary diagnoses were malaria (22%), sepsis (18%), respiratory tract infections (12%), and trauma (6%). The mortality rate was 25%. Mortality rates were highest among patients with sepsis (59%), encephalopathy (56%), noninfectious CNS pathologies (33%), neoplastic diseases (33%), meningitis/encephalitis (29%), burns (26%), and cardiovascular pathologies (26%). The median length of PICU stay was 2 days. HIV exposure/infection had a nonstatistically significant association with mortality. Patients admitted for burns had the highest median length of PICU stay (4 d). Most trauma admissions were male (75%), and approximately half of all trauma admissions had an associated head injury (55%). Conclusions: Infectious disease and trauma were highly represented in this Mozambican PICU, and overall mortality was high compared with high-income countries. With this knowledge, targeted collaborative projects in Mozambique can now be created and modified. Further research is needed to monitor the potential benefits of such interventions. This work was performed at Hospital Central de Maputo, Universidade Eduardo Mondlane, Maputo, Mozambique. The findings and conclusions presented are those of the authors and do not necessarily represent the official position of the funding agencies. This partnership has been supported, in part, by the President’s Emergency Plan for AIDS Relief through the Health Resources and Services Administration under the terms of Cooperative Agreement U97HA04128. This partnership, as well as this research study, has been supported by Anadarko Petroleum, the UCLA Center for World Health, Mending Kids International, Sun West Mortgage, the UCLA AIDS Institute, the NIH/NCRR/NCATS UCLA CTSI Grant UL1TR000124, and the Department of Surgery at the David Geffen School of Medicine at UCLA. Drs. Hall, Seni, DeUgarte, and Kelly received support for article research from the National Institutes of Health. Drs. Hall’s, Seni’s, Buck’s, and Kelly’s institutions received funding from President’s Emergency Plan for AIDS Relief through the Health Resources and Services Administration under the terms of Cooperative Agreement U97HA04128, Mending Kids International, Sun West Mortgage, and Anadarko Petroleum. Dr. Hartford disclosed that she was employed by the University of California Los Angeles as a pediatrician and partnership director for the partnership between UCLA and Maputo Central Hospital during the study data collection time frame. The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Robert B. Kelly, MD, Children’s Hospital of Orange County, 1201 West La Veta Avenue, Orange, CA 92868. E-mail: rkelly@choc.org ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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