Changing Patterns of Disease and Mortality at the Children’s Hospital, Accra: Are Infections Rising?
Identifieur interne : 000110 ( Pmc/Checkpoint ); précédent : 000109; suivant : 000111Changing Patterns of Disease and Mortality at the Children’s Hospital, Accra: Are Infections Rising?
Auteurs : Edem M. A. Tette [Ghana] ; Margaret Neizer [Ghana] ; Maame Yaa Nyarko [Ghana] ; Eric K. Sifah [Ghana] ; Edmund T. Nartey [Ghana] ; Eric S. Donkor [Ghana]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
The Millennium Development Goals (MDGs) have led to reductions in child mortality world-wide. This has, invariably, led to the changes in the epidemiology of diseases associated with child mortality. Although facility based data do not capture all deaths, they provide an opportunity to confirm diagnoses and insight into these changes which are relevant for further disease control.
To identify changes in the disease pattern of children who died at the Princess Marie Louise Children’s Hospital (PML) in Ghana from 2003–2013.
A cross sectional review of mortality data was carried out at PML. The age, sex, duration of admission and diagnosis of consecutive patients who died at the hospital between 2003 and 2013 were reviewed. This information was entered into an Access database and analysed using Stata 11.0 software.
Altogether, 1314 deaths (3.6%) occurred out of a total of 37,012 admissions. The majority of the deaths, 1187 (90.3%), occurred in children under the age of 5 years. While deaths caused by malaria, malnutrition, HIV infection and diarrhoea decreased, deaths caused by pneumonia were rising. Suspected septicaemia and meningitis showed a fluctuating trend with only a modest decrease between 2012 and 2013. The ten leading causes of mortality among under-fives were malnutrition, 363 (30.6%); septicaemia, 301 (25.4%); pneumonia, 218 (18.4%); HIV infection, 183 (15.4%); malaria, 155 (13.1%); anaemia, 135 (11.4%); gastroenteritis/dehydration, 110 (9.3%); meningitis, 58 (4.9%); tuberculosis, 34 (2.9%) and hypoglycaemia, 27 (2.3%). For children aged 5–9 years, the leading causes of mortality were malaria, 42 (42.9%); HIV infection, 27 (27.6%); anaemia, 14 (14.3%); septicaemia, 12 (12.2%); meningitis, 10 (10.2%); malnutrition, 9 (9.2%); tuberculosis, 5 (5.1%); pneumonia, 4 (4.1%); encephalopathy, 3 (3.1%); typhoid fever, 3 (3.1%) and lymphoma, 3 (3.1%). In the adolescent age group, malaria, 8 (27.6%); anaemia, 6 (20.7%); HIV infection, 5 (17.2%); sickle cell disease, 3 (10.3%) and meningitis, 3 (10.3%) were most common.
There has been a decline in the under-five mortality at PML over the years; however, deaths caused by pneumonia appear to be rising. This highlights the need for better diagnostic services, wider HIV screening and clinical audits to improve outcomes in order to achieve further reductions in child mortality and maintain the gains.
Url:
DOI: 10.1371/journal.pone.0150387
PubMed: 27045667
PubMed Central: 4821618
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A." last="Tette">Edem M. A. Tette</name><affiliation wicri:level="4"><nlm:aff id="aff001"><addr-line>Department of Community Health, School of Public Health, University of Ghana, Legon, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, School of Public Health, University of Ghana, Legon</wicri:regionArea><orgName type="university">Université du Ghana</orgName><placeName><settlement type="city">Accra</settlement><settlement type="town">Legon (Ghana)</settlement><region type="region">Région du Grand Accra</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Princess Marie Louis Children’s Hospital, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Princess Marie Louis Children’s Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Neizer, Margaret" sort="Neizer, Margaret" uniqKey="Neizer M" first="Margaret" last="Neizer">Margaret Neizer</name><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Princess Marie Louis Children’s Hospital, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Princess Marie Louis Children’s Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Nyarko, Maame Yaa" sort="Nyarko, Maame Yaa" uniqKey="Nyarko M" first="Maame Yaa" last="Nyarko">Maame Yaa Nyarko</name><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Princess Marie Louis Children’s Hospital, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Princess Marie Louis Children’s Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Sifah, Eric K" sort="Sifah, Eric K" uniqKey="Sifah E" first="Eric K." last="Sifah">Eric K. Sifah</name><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Princess Marie Louis Children’s Hospital, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Princess Marie Louis Children’s Hospital, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Nartey, Edmund T" sort="Nartey, Edmund T" uniqKey="Nartey E" first="Edmund T." last="Nartey">Edmund T. Nartey</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Legon, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Legon</wicri:regionArea><orgName type="university">Université du Ghana</orgName><placeName><settlement type="city">Accra</settlement><settlement type="town">Legon (Ghana)</settlement><region type="region">Région du Grand Accra</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff004"><addr-line>Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon</wicri:regionArea><orgName type="university">Université du Ghana</orgName><placeName><settlement type="city">Accra</settlement><settlement type="town">Legon (Ghana)</settlement><region type="region">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Donkor, Eric S" sort="Donkor, Eric S" uniqKey="Donkor E" first="Eric S." last="Donkor">Eric S. Donkor</name><affiliation wicri:level="4"><nlm:aff id="aff005"><addr-line>Department of Medical Microbiology, College of Health Sciences, University of Ghana, Legon, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medical Microbiology, College of Health Sciences, University of Ghana, Legon</wicri:regionArea><orgName type="university">Université du Ghana</orgName><placeName><settlement type="city">Accra</settlement><settlement type="town">Legon (Ghana)</settlement><region type="region">Région du Grand Accra</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>The Millennium Development Goals (MDGs) have led to reductions in child mortality world-wide. This has, invariably, led to the changes in the epidemiology of diseases associated with child mortality. Although facility based data do not capture all deaths, they provide an opportunity to confirm diagnoses and insight into these changes which are relevant for further disease control.</p></sec><sec id="sec002"><title>Objective</title><p>To identify changes in the disease pattern of children who died at the Princess Marie Louise Children’s Hospital (PML) in Ghana from 2003–2013.</p></sec><sec id="sec003"><title>Methods</title><p>A cross sectional review of mortality data was carried out at PML. The age, sex, duration of admission and diagnosis of consecutive patients who died at the hospital between 2003 and 2013 were reviewed. This information was entered into an Access database and analysed using Stata 11.0 software.</p></sec><sec id="sec004"><title>Results</title><p>Altogether, 1314 deaths (3.6%) occurred out of a total of 37,012 admissions. The majority of the deaths, 1187 (90.3%), occurred in children under the age of 5 years. While deaths caused by malaria, malnutrition, HIV infection and diarrhoea decreased, deaths caused by pneumonia were rising. Suspected septicaemia and meningitis showed a fluctuating trend with only a modest decrease between 2012 and 2013. The ten leading causes of mortality among under-fives were malnutrition, 363 (30.6%); septicaemia, 301 (25.4%); pneumonia, 218 (18.4%); HIV infection, 183 (15.4%); malaria, 155 (13.1%); anaemia, 135 (11.4%); gastroenteritis/dehydration, 110 (9.3%); meningitis, 58 (4.9%); tuberculosis, 34 (2.9%) and hypoglycaemia, 27 (2.3%). For children aged 5–9 years, the leading causes of mortality were malaria, 42 (42.9%); HIV infection, 27 (27.6%); anaemia, 14 (14.3%); septicaemia, 12 (12.2%); meningitis, 10 (10.2%); malnutrition, 9 (9.2%); tuberculosis, 5 (5.1%); pneumonia, 4 (4.1%); encephalopathy, 3 (3.1%); typhoid fever, 3 (3.1%) and lymphoma, 3 (3.1%). In the adolescent age group, malaria, 8 (27.6%); anaemia, 6 (20.7%); HIV infection, 5 (17.2%); sickle cell disease, 3 (10.3%) and meningitis, 3 (10.3%) were most common.</p></sec><sec id="sec005"><title>Conclusion</title><p>There has been a decline in the under-five mortality at PML over the years; however, deaths caused by pneumonia appear to be rising. This highlights the need for better diagnostic services, wider HIV screening and clinical audits to improve outcomes in order to achieve further reductions in child mortality and maintain the gains.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bryce, J" uniqKey="Bryce J">J Bryce</name></author><author><name sortKey="Victora, Cg" uniqKey="Victora C">CG Victora</name></author><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gyamfi, S" uniqKey="Gyamfi S">S Gyamfi</name></author><author><name sortKey="Peprah, Tp" uniqKey="Peprah T">TP Peprah</name></author><author><name sortKey="Toboh, L" uniqKey="Toboh L">L Toboh</name></author><author><name sortKey="Amedoe, Ja" uniqKey="Amedoe J">JA Amedoe</name></author><author><name sortKey="Quansah Asare, Gj" uniqKey="Quansah Asare G">GJ 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27045667</article-id><article-id pub-id-type="pmc">4821618</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0150387</article-id><article-id pub-id-type="publisher-id">PONE-D-15-39527</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health 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Sciences</subject><subj-group><subject>Nutrition</subject><subj-group><subject>Malnutrition</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Infectious Diseases of the Nervous System</subject><subj-group><subject>Meningitis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Neurology</subject><subj-group><subject>Infectious Diseases of the Nervous System</subject><subj-group><subject>Meningitis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Inflammatory Diseases</subject><subj-group><subject>Meningitis</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and health sciences</subject><subj-group><subject>Infectious diseases</subject><subj-group><subject>Viral diseases</subject><subj-group><subject>HIV infections</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Diagnostic Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Septicemia</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Septicemia</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Immunodeficiency Viruses</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and life sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>RNA viruses</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Medical Microbiology</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Pathogens</subject><subj-group><subject>Microbial Pathogens</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Viruses</subject><subj-group><subject>Viral Pathogens</subject><subj-group><subject>Retroviruses</subject><subj-group><subject>Lentivirus</subject><subj-group><subject>HIV</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Hematology</subject><subj-group><subject>Anemia</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Changing Patterns of Disease and Mortality at the Children’s Hospital, Accra: Are Infections Rising?</article-title><alt-title alt-title-type="running-head">Disease Pattern and Mortality at the Children's Hospital, Accra</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tette</surname><given-names>Edem M. A.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Neizer</surname><given-names>Margaret</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Nyarko</surname><given-names>Maame Yaa</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Sifah</surname><given-names>Eric K.</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Nartey</surname><given-names>Edmund T.</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Donkor</surname><given-names>Eric S.</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Community Health, School of Public Health, University of Ghana, Legon, Ghana</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Princess Marie Louis Children’s Hospital, Accra, Ghana</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Legon, Ghana</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Department of Medical Microbiology, College of Health Sciences, University of Ghana, Legon, Ghana</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Arez</surname><given-names>Ana Paula</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Instituto de Higiene e Medicina Tropical, PORTUGAL</addr-line></aff><author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist</p></fn><fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: EMAT MN MYN EKS ETN. Performed the experiments: EMAT ETN. Analyzed the data: ETN EMAT. Contributed reagents/materials/analysis tools: EMAT ETN EKS ESD. Wrote the paper: EMAT MN MYN EKS ETN ESD.</p></fn><corresp id="cor001">* E-mail: <email>edemenator@googlemail.com</email></corresp></author-notes><pub-date pub-type="epub"><day>5</day><month>4</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>4</issue><elocation-id>e0150387</elocation-id><history><date date-type="received"><day>9</day><month>9</month><year>2015</year></date><date date-type="accepted"><day>12</day><month>2</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Tette et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Tette et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0150387.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>The Millennium Development Goals (MDGs) have led to reductions in child mortality world-wide. This has, invariably, led to the changes in the epidemiology of diseases associated with child mortality. Although facility based data do not capture all deaths, they provide an opportunity to confirm diagnoses and insight into these changes which are relevant for further disease control.</p></sec><sec id="sec002"><title>Objective</title><p>To identify changes in the disease pattern of children who died at the Princess Marie Louise Children’s Hospital (PML) in Ghana from 2003–2013.</p></sec><sec id="sec003"><title>Methods</title><p>A cross sectional review of mortality data was carried out at PML. The age, sex, duration of admission and diagnosis of consecutive patients who died at the hospital between 2003 and 2013 were reviewed. This information was entered into an Access database and analysed using Stata 11.0 software.</p></sec><sec id="sec004"><title>Results</title><p>Altogether, 1314 deaths (3.6%) occurred out of a total of 37,012 admissions. The majority of the deaths, 1187 (90.3%), occurred in children under the age of 5 years. While deaths caused by malaria, malnutrition, HIV infection and diarrhoea decreased, deaths caused by pneumonia were rising. Suspected septicaemia and meningitis showed a fluctuating trend with only a modest decrease between 2012 and 2013. The ten leading causes of mortality among under-fives were malnutrition, 363 (30.6%); septicaemia, 301 (25.4%); pneumonia, 218 (18.4%); HIV infection, 183 (15.4%); malaria, 155 (13.1%); anaemia, 135 (11.4%); gastroenteritis/dehydration, 110 (9.3%); meningitis, 58 (4.9%); tuberculosis, 34 (2.9%) and hypoglycaemia, 27 (2.3%). For children aged 5–9 years, the leading causes of mortality were malaria, 42 (42.9%); HIV infection, 27 (27.6%); anaemia, 14 (14.3%); septicaemia, 12 (12.2%); meningitis, 10 (10.2%); malnutrition, 9 (9.2%); tuberculosis, 5 (5.1%); pneumonia, 4 (4.1%); encephalopathy, 3 (3.1%); typhoid fever, 3 (3.1%) and lymphoma, 3 (3.1%). In the adolescent age group, malaria, 8 (27.6%); anaemia, 6 (20.7%); HIV infection, 5 (17.2%); sickle cell disease, 3 (10.3%) and meningitis, 3 (10.3%) were most common.</p></sec><sec id="sec005"><title>Conclusion</title><p>There has been a decline in the under-five mortality at PML over the years; however, deaths caused by pneumonia appear to be rising. This highlights the need for better diagnostic services, wider HIV screening and clinical audits to improve outcomes in order to achieve further reductions in child mortality and maintain the gains.</p></sec></abstract><funding-group><funding-statement>The study was supported by Building Stronger Universities Initiative Platform on Human Health (BSU-PHH). BSU-PHH had no role in the design, analysis or writing of this article</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="6"></table-count><page-count count="12"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>Data belong to a third party, the PML Children's Hospital, Ghana Health Service, and are available for researchers who meet the criteria for access to confidential data. Requests for the data should be addressed to: Dr Ebenezer Appiah-Denkyirah Director General of the Ghana Health Service email address: <email>ebenezer.appiahdenkyira@ghsmail.org</email>. The request should provide details of what the data is supposed to be used for, it should meet the requirements of the Ethical Review Committee of the Ghana Health Service and it is supposed to be used for the purpose defined in the request or research protocol.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>Data belong to a third party, the PML Children's Hospital, Ghana Health Service, and are available for researchers who meet the criteria for access to confidential data. Requests for the data should be addressed to: Dr Ebenezer Appiah-Denkyirah Director General of the Ghana Health Service email address: <email>ebenezer.appiahdenkyira@ghsmail.org</email>. The request should provide details of what the data is supposed to be used for, it should meet the requirements of the Ethical Review Committee of the Ghana Health Service and it is supposed to be used for the purpose defined in the request or research protocol.</p></notes></front></pmc><affiliations><list><country><li>Ghana</li></country><region><li>Région du Grand Accra</li></region><settlement><li>Accra</li><li>Legon (Ghana)</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Tette, Edem M A" sort="Tette, Edem M A" uniqKey="Tette E" first="Edem M. A." last="Tette">Edem M. A. Tette</name></region><name sortKey="Donkor, Eric S" sort="Donkor, Eric S" uniqKey="Donkor E" first="Eric S." last="Donkor">Eric S. Donkor</name><name sortKey="Nartey, Edmund T" sort="Nartey, Edmund T" uniqKey="Nartey E" first="Edmund T." last="Nartey">Edmund T. Nartey</name><name sortKey="Nartey, Edmund T" sort="Nartey, Edmund T" uniqKey="Nartey E" first="Edmund T." last="Nartey">Edmund T. Nartey</name><name sortKey="Neizer, Margaret" sort="Neizer, Margaret" uniqKey="Neizer M" first="Margaret" last="Neizer">Margaret Neizer</name><name sortKey="Nyarko, Maame Yaa" sort="Nyarko, Maame Yaa" uniqKey="Nyarko M" first="Maame Yaa" last="Nyarko">Maame Yaa Nyarko</name><name sortKey="Sifah, Eric K" sort="Sifah, Eric K" uniqKey="Sifah E" first="Eric K." last="Sifah">Eric K. Sifah</name><name sortKey="Tette, Edem M A" sort="Tette, Edem M A" uniqKey="Tette E" first="Edem M. A." last="Tette">Edem M. A. Tette</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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