Childhood dead-before-arrival at a Nigerian tertiary health facility: A call for concern and improvement in health care delivery

Abstract

Background: Dead-before-arrival (DBA) is a term used to describe patients who had no sign of life at the time of presentation to the hospital. Little information exists about it in children. This study sets out to determine the prevalence and pattern of DBA among children presenting to a tertiary health facility in Nigeria. Materials and Methods: Standardized verbal autopsy was used to ascertain the details about children aged 1 month to 14 years who were cases of DBA at the Children Emergency Ward of the Wesley Guild Hospital, Ilesa, Nigeria, over 12 months. Socio-demographic history, symptoms before demise, treatment received, and suspected cause (s) of death were documented. The prevalence of DBA was compared to the in-hospital mortality during the period. Results: A total of 64 (7.4%) of the 863 emergency admissions were cases of DBA. Median (interquartile range) age was 18.0 (8.0–52.5) months, male: female was 1.7 and over 78.1% were under-fives. Infections such as malaria, sepsis, and gastroenteritis were the most common suspected causes of death, followed by accidental injuries from a road traffic crash, drowning, and aspirations. Cases of DBA were significantly higher than in-hospital mortality during the study period (7.4% vs. 5.6%). Conclusion: In-hospital mortality may be a tip of the iceberg as cases of DBA, and those who did not present to the hospital at all may take the lion share of childhood mortality. Making basic health care available and affordable to the populace may help reduce the burden of DBA.

Keywords

• children emergency
• dead-before-arrival
• mortality
• verbal autopsy