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Journal of Tropical Pediatrics 2004 50(3):158-163; doi:10.1093/tropej/50.3.158
© 2004 by Oxford University Press
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The Causes of Hospital Admission and Death among Children in Bamako, Mali

James D. CampbellA1,, Samba O. SowA2, Myron M. LevineA1 and Karen L. KotloffA1

A1 University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, Maryland, USA A2 Centre pour les Vaccins en Développement, Mali (CVD-Mali), Centre National d’Appui à la lutte contre la Maladie (CNAM), Ministière de la Santé, Bamako, Mali

The health burden and mortality caused by infections during childhood remain large in sub-Saharan Africa.We performed a review of the causes of hospitalization and death among children admitted to a pediatric teaching hospital in Bamako, Mali. Medical records of children admitted throughout 2000 were systematically sampled and abstracted for demographics, diagnosis, hospital course, and disposition. A sample of 1644 charts, from 5001 admitted children, were abstracted. The median age was 8 months. Half of the children had a febrile illness. All diagnoses were made clinically. The annual incidence per 100 000 and case fatality rates of the four most common serious infections, excluding malaria, were as follows: pneumonia, 165 (12 per cent); sepsis, 75 (37 per cent); meningitis, 71 (20 per cent); and enteric fever, 14 (12 per cent). An estimated 1300 children were admitted with thick-smear confirmed malaria; at least 64 per cent met World Health Organization criteria for severe malaria and 11 per cent died. Seventy-one per cent of admissions were due to infections. Overall 21 per cent of children admitted died in the hospital, most within the first 3 days of admission. Infectious diseases remain the primary cause of hospitalization among Malian children and frequently lead to death. A substantial proportion of this morbidity and mortality is probably attributable to vaccine-preventable diseases, such as Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis. Prospective surveillance using microbiological data is needed to delineate the organism-specific burdens.

* Correspondence: James D. Campbell, M.D., University of Maryland, Baltimore, Center for Vaccine Development – HSF 480, 685 West Baltimore Street, Baltimore, Maryland 21201, USA. E-mail <jcampbel{at}medicine.umaryland.edu>.


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