Paediatric admissions to a rural South African hospital: Value of hospital data in helping to define intervention priorities and allocate district resources

Objective. To audit paediatric medical admissions to a rural district hospital in order to help define intervention priorities and allocate district resources. Design. Prospective audit of consecutive admissions to the paediatric medical service of Hlabisa Hospital, KwaZulu-Natal, between March 1995 and February 1996. Main outcome measures. Number of admissions, month of admission, age, sex, diagnosis, nutritional status, HIV status, outcome and length of stay. Results. Of 1 364 children admitted, 995 (73%) were aged under 24 months and 584 (43%) were either underweight for age or severely malnourished. Acute respiratory tract infection (384, 28%), acute diarrhoea (200, 15%), dysentery (168, 12%) and severe malnutrition (149, 11 %) were the major causes for admission and were responsible for most deaths (113, 75%). The overall case fatality rate was 11 % and most (90, 60%) died within 48 hours of admission. Forty-five per cent of the 332 children tested were HIV-positive. Conclusion. Most severe morbidity and mortality result from four common conditions, reflecting poor socioeconomic conditions in the area. Opportunities for clincial intervention to reduce their impact include identification of 'at risk' children, focusing care early in admissions, use of standardised protocols of care, and integrated management of the sick child.