Patterns and Trends in the Attributable Fractions of under-5 Years Hospitalization and Inpatient Death for Neonates, Infectious Diseases, and Severe Acute Malnutrition in Yemen: A Retrospective Data Analysis
Keywords:Infectious diseases, SAM, neonates, under-5, Yemen.
Objectives: To examine trends in hospitalization and inpatient deaths of neonates, and infectious diseases (IDs) between 2005-2014; and severe acute malnutrition (SAM) between 2010 and 2014 in Yemen.
Method: It was a retrospective descriptive study. Data were extracted from the clinical records of the patients admitted from 2005 to 2014 for neonates and cases aged 1-59 months with IDs. For cases with SAM data were available from 2010 to 2014. Data were analyzed using SPSS version 20.
Results: Between 2005 and 2014, 39282 under-5 hospitalized and 33.6% were neonates. Of 26069 aged 1-59 months, 15224(58.4%) hospitalized with IDs. Pneumonia (44.6%), diarrhea (29.9%), and meningitis (10.6%) were the main subgroups. During the study period, there were 4183 under-5 deaths. Neonatal deaths accounting for 3671 (87.8%). Deaths aged 1-59 month were 512(12.2%) and IDs contributing 440(85.9%). Compared to 2005/06, neonatal hospitalization and death declined by 9.2% and 18.1% in 2013/14, and IDs by 56.8% and 79.2%, respectively. Pneumonia reductions were 65.4% and 83.7%, diarrhea 42% and 95.5%, and meningitis 73% and 83%, respectively. Between 2010-2014, SAM cases were 1781 of 13689 total hospitalization [13% (95%CI 12.5-13.6)] and 53 SAM deaths of 224 total deaths [23.7 % (18.6-29.6)]. SAM hospitalization rate increased from 8.5% in 2010, to 18.4% in 2014 and death rate increased from 27% (17.6-39.0) to 57.5% (42.2-71.5), respectively.
Conclusion: Despite significant decline in IDs and vaccine preventable diseases, this study showed 87.8% of under-5 mortality were neonates. The increasing trends in SAM hospitalization and death are alarming. Interventions to improve neonatal survival and to reduce SAM morbidity and mortality are urgently needed.
 Liu L, Oza S, Hogan D, Perin J, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385(9966): 430-440.
 Källander K, Hildenwall H, Waiswa P, et al. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ 2008; 86: 332-338.
 English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, et al. Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya. Lancet 2004; 363: 1948-53.
 Nolan T, Angos P, Cunha A, Muhe L, Qazi S, et al. Quality of hospital care for seriously ill children in less-developed countries. The Lancet 2001; 357: 106-110.
 Irimu GW, Gathara D, Zurovac D, Kihara H, Maina C, et al. Performance of Health Workers in the Management of Seriously Sick Children at a Kenyan Tertiary Hospital: Before and after a Training Intervention. PLoS ONE 2012; 7(7): e39964.
 Tornheim JA, Manya AS, Oyando N, Kabaka S, Breiman RF, Feikin DR. The epidemiology of hospitalized pneumonia in rural Kenya: the potential of surveillance data in setting public health priorities. International Journal of Infectious Diseases 2007; 11: 536-543.
 Armstrong Shellenberg JR, Nathan R, Abdulla S, et al. Risk factors for child mortality in rural Tanzania. Trop Med Int Health 2002; 7: 506-511.
 Regional Office for the Eastern Mediterranean, WHO 2014. Eastern Mediterranean Region: Framework for health information systems and core indicators for monitoring health situation and health system performance. http://applications.emro.who.int/dsaf/EMROPUB_2014_EN_1792.pdf?ua=1
 UN Inter-agency Group for Child Mortality Estimation. Levels and trends in child mortality: report 2015. UNICEF, New York 2015.
 Annual statistics reports. Ministry of Public Health and population, Yemen 2011-2014.
 World Health Organization. Pocket book for hospital care of children: guidelines for the management of common illness with limited resources. Second edition. WHO, Geneva 2013.
 WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization 2013.
 Centers for Disease Control and Prevention: Office of the Associate Director for Science. Distinguishing Public Health Research and Public Health Non-research 2010. Available: http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf.
 Bhutta ZA, Das JK, Bahl R, Lawn JE, et al. for The Lancet Interventions Review Group and The Lancet Every Newborn Study Group. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet 2014; 384: 347-70.
 Fischer-Walker CL, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhea. Lancet 2013; 381(9875): 1405-16.
 UNICEF Committing to child survival: a promise renewed-progress report 2014. New York; NY; UNICEF 2014.
 Banajeh SM, Abu-Asba BA. The epidemiology of all-cause and rotavirus acute gastroenteritis and the characteristics of rotavirus circulating strains before and after rotavirus vaccine introduction in Yemen: analysis of hospital-based surveillance data. BMC Infectious Diseases 2015; 15: 418.
 Becker-Dreps S, Bucardo F, Vilshez S, Zambrana LE, Liu L, Weber DJ, et al. Etiology of childhood diarrhea after rotavirus vaccine introduction: a prospective population-based study in Nicaragua. Pediatr Infect Dis J 2014; 33: 1156-63.
 Bucardo F, Reyes Y, Svensson L, Nordgren J. Predominance of Norovirus and Sapovirus in Nicaragua after Implementation of Universal Rotavirus Vaccination. PLoS ONE 2014; 9(5): e98201.
 Zar HJ, Barnett W, Stadler A, Gardner-Lubbe S, Mayor L, Nicol MP. Aetiology of childhood pneumonia in a well vaccinated South African birth cohort: a nested case-control study of the Drankenstein Child Health Study. Lancet Respir Med 2016; 4: 463-472.
 Qazi S, Aboubaker S, Maclean R, et al. Ending preventable child deaths from pneumonia and diarrhea by 2025:the integrated global action plan for pneumonia and diarrhea. Arch Dis Child 2015; 100(Suppl 1): 23-28.
 WHO/UNICEF. Ending preventable child deaths from pneumonia and diarrhea by 2025: the integrated global action plan for pneumonia and diarrhea. Geneva: WHO 2013.
 Leung DT, Chisti MJ, Pavia A. Prevention and control of childhood pneumonia and diarrhea. Pediatr Clin N Am 2016; 63: 67-79.
 Jamison DT, Murphy SM, Sandbu ME. Why has under-5 mortality decreased at such different rates in different countries? Journal of Health Economics 2016; 48: 16-25.
 Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382(9890): 427-51.
 Berkley JA, Ngari M, Thitiri J, et al. Daily co-trimoxazole prophylaxis to prevent mortality in children with complicated severe acute malnutrition: a multicentre, double-blind, randomised placebo-controlled trial. Lancet Glob Health 2016; published online June 2.
 Kerac M, Bunn J, Chagaluka G, Bahwere P, Tomkins A, et al. Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition(Fu SAM study): a prospective cohort study. PLoS ONE 2014; 9(6): e 96030.
 Chisti MJ, Graham SM, Duke T, et al. Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. PLoS ONE 2014; 9: e 107663.
 Duke T, Yano E, Hutchinson A, Hawihwanje I, Aipit J, Tovilu M, et al. Large-scale data reporting of pediatric morbidity and mortality in developing countries: it can be done. Arch Dis Child 2016; 101: 392-397.
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