The changing trends in paediatric hospital admissions at Chris Hani Baragwanath Hospital 1992 - 1997

Abstract

Rates of infection with the Human Immunodeficiency Virus (HIV) have been increasing steadily in South Africa over the last decade The focus of this study is to determine the changes over time in prevalence of HIV infection amongst hospitalised children, and its effects on the profile of disease and in hospital mortality over the time period 1992 to 1997. Methods Analysis: The routine computerised database held in the Department of Paediatrics at Chris Hani Baragwanath Hospital was used. Subjects included admissions to the paediatric medical wards between 1st January 1992 and 30th April 1997 HIV results are available only for patients who have been tested, with informed consent, for clinical indications. Results: Records were available for 22 633 admissions involving 19 918 children. Total annual admissions increased by 23.6% between 1992 and 1996 Prevalence of HIV infection increased from 2.9% in 1992 to 20% in 1997 HIV infected children had a younger age distribution (p<0.001) and longer median length of stay (p<0 001) compared with HIV negative and untested children HIV infection accounted for a disproportionate number of admissions for pneumonia ;p<0 001), gastro-enteritis (p<0 001), malnutrition (p<0.001) and tuberculosis (p-'O u l), and accounted for the rise in absolute numbers of admissions for these Diagnoses HIV negative children showed declining rates o f malnutrition, vaccine-prevenlai - diseases and admission to the Intensive Care Unit (p =0.001) o .e r the study period. In-hospital mortality for all children increased by 42% from 4 3% in 1992 to 6.1% in 1997. Mortality was 13.2% in the HIV infected children compared to 5 1% in uninfected children and 3.1% in untested children (p<0.001) Mortality rates in uninfected children declined over time from 5.3% in 1992 to 4.6% in 1996 (p=0.06). The proportion o f all deaths that were HIV positive increased from 6.7% in 1992 to 54.3% in 1997 (p<0.001) The most common causes o f death were pneumonia (24.6%), septicaemia (12 2%) and gastro-enteritis (9.5%) for all children, with pneumonia assuming a greater proportion in :he HIV infected group (52.8%) (pCO.OOl). Conclusion: Paediatric H IV infection has changed the profile cfpaediatric admission diagnoses and increased in-hospital mortality in the relatively short time period between 1992 and 1997. The trends seen in this study are expected to continue well into the fu tu re and should he taken into consideration in planning staffing and health service funding in the future.