Pattern of admissions to the paediatric medical wards (1995 to 1996) at Harare Hospital, Zimbabwe.

OBJECTIVE: To document the pattern of disease and outcome of medical paediatric admissions at Harare hospital. DESIGN: Cross sectional study from 1 June 1995 to 30th May 1996. SETTING: Medical paediatric wards, Harare Central Hospital. SUBJECTS: All admissions below the age of nine years. MAIN OUTCOME MEASURES: Socio-demographic features, nutritional status, clinical diagnoses, duration of hospital stay and mortality. RESULTS: A total of 8,826(90.0%) of the admissions were assessed. The majority(51.8%) of the patients were one year and below. "Road to Health" cards, available for 94.4% children, showed 88.0% had appropriate immunizations for age. Forty nine percent had lower respiratory tract infection either as only, or concurrent with other diagnoses, with an overall fatality rate of 16.2%. Acute diarrhoea was the second most frequent condition (21.0%) with an associated case fatality rate of 11.3%. Mortality rates for neonatal sepsis and bacterial meningitis were 12.3% and 32.8% respectively. Severe malnutrition defined as less than 60% of the expected weight for age, was present in 12.5% with an associated fatality rate of 28.7%. Based on clinical suspicion 23.2% of the total children were tested for HIV antibodies and 82.0% were positive. Overall case fatality among the inpatients was 17.8% and 36.7% of the total deaths occurred within 24 hours of admission. CONCLUSION: There is a need to re-evaluate our management strategies for common conditions including those with HIV infection. Standardization of case management is an important and essential step towards reduction in mortality both at the primary and referral health institutions.

Congenital heart disease in Zimbabwean children.

A descriptive study was undertaken to document the pattern, management and immediate outcome of surgery in children with congenital heart disease referred to the cardiology clinic. On presentation a physical examination, chest radiogram, electrocardiogram and cross-sectional echocardiogram were performed. Two hundred and eighty-six children seen over a period of 18 months between 1990 and 1992 were included in the study. Their ages ranged from 2 days to 15 years (median 23 months) and the male to female ratio was 1:1.1. The predominant lesions were ventricular septal defect (32.9%), tetralogy of Fallot (19.6%) and patent ductus arteriosus (11.9%). Seventy-three children (26%) had surgery, with a mortality of 5.5%. There was a pattern of late presentation (68.2% after 1 year of age) accompanied by a high rate of complications. There was also an under-representation of lesions which have a high mortality in infancy.