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Muttalib F, Memon ZA, Muhammad S, Soomro A, Khan S, Bano S, Jawwad M, Soofi S, Hansen B, Adhikari NK, Bhutta Z. The spectrum of acute illness and mortality of children and adolescents presenting to emergency services in Sanghar district hospital, Pakistan: a prospective cohort study. BMJ Open 2024; 14:e082255. [PMID: 39179281 DOI: 10.1136/bmjopen-2023-082255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan. DESIGN Prospective cohort study. SETTING Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020. PARTICIPANTS 3850 children 0-14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department. OUTCOME MEASURES The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment. RESULTS Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age <28 days) was associated with increased odds of death (OR 4.34 [95% CI 2.38 to 8.18], p<0.001, reference age 28 days-14 years) and there was no significant difference in odds of death between female vs male children (OR 1.12, 95% CI 0.6 to 2.04, p=0.72). 47 children died in the hospital (3.6%) and three (0.2%) died within 28 days of admission. Most children who died were <28 days old (n=32/50, 64%); leading diagnoses included neonatal sepsis/meningitis (n=13/50, 26%), neonatal encephalopathy (n=7/50, 14%) and lower respiratory tract infections (n=6/50, 12%). Delays in care-seeking (n=15) and in receiving appropriate treatment (n=12) were common. CONCLUSION This study adds to sparse literature surrounding the epidemiology of disease and hospital outcomes for children with acute illness seeking healthcare in rural Pakistan and, in particular, among children aged 5-14 years. Further studies should include public and private hospitals within a single region to comprehensively describe patterns of care-seeking and interfacility transfer in district health systems.
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Affiliation(s)
- Fiona Muttalib
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Zahid Ali Memon
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shah Muhammad
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Asif Soomro
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Samia Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shazia Bano
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Jawwad
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Neill Kj Adhikari
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Managament, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zulfiqar Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Farooq W, Kazi K, Saleem SG, Ali S. Epidemiology and clinical characteristics of adult patients presenting to a low resource, tertiary care emergency department in Pakistan: Challenges & Outcomes. Pak J Med Sci 2024; 40:S21-S27. [PMID: 38328639 PMCID: PMC10844921 DOI: 10.12669/pjms.40.2(icon).8975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/19/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024] Open
Abstract
Objectives Emergency Departments (EDs) play a major role in managing acute and chronic illnesses, especially in low-to-middle-income countries like Pakistan, which lacks effective primary healthcare. This study reports the epidemiology and clinical characteristics of patients presenting over a two-year period at the Indus Hospital and Health Network (IHHN) adult ED in Karachi, Pakistan. Methods This is a retrospective observational study conducted through chart review of 264,859 patients, aged 16 years and above, who presented to the IHHN ED, Korangi Campus, from January 2019 to December 2020 after obtaining approval from IHHN IRB. Results Men were found to be the predominant presenting gender, with a slight rise in the number of women in 2020. The most frequent age group in 2019 was 15-25 (27.7%), whereas it was 25-35 years in 2020 (24.1%), with a decline in total number of elderly visits seen in comparison to previous years. The most frequently seen disposition was 'referral to clinic' in 2019 (48.4%) and 'discharged' in 2020 (39%). Out of all dispositions, maximum Length of stay (LOS) was seen in patients who left against medical advice in both years. Patient acuity showed the highest number of P3 (moderately ill) patients in both years. Infectious diseases accounted for greater than 10% of patients in both years (17.2% and16.5%), followed by gastrointestinal complaints (15.7% and 11.3%), genitourinary complaints (14.9% and 7.9%), and trauma (11.9% and 12.4%). Conclusion Knowledge of epidemiology and clinical characteristics of patients can help facilitate timely planning of staff deployment and allocation of resources to avoid overcrowding, improve patient outcomes, and increase patient satisfaction through timely management.
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Affiliation(s)
- Wasfa Farooq
- Wasfa Farooq, MBBS, MSc. Pediatric Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Kulsum Kazi
- Kulsum Kazi, MBBS. Research Department, Indus Hospital & Health Network, Karachi, Pakistan
| | - Syed Ghazanfar Saleem
- Syed Ghazanfar Saleem, MBBS, FCPS. Emergency Services, Indus Hospital & Health Network, Karachi, Pakistan
| | - Saima Ali
- Saima Ali, MBBS, FCPS, MHPE. Emergency Services, Indus Hospital & Health Network, Karachi, Pakistan
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El Zahran T, Ghandour L, Chami A, Saliba N, Hitti E. Comparing emergency department visits 10-year apart at a tertiary care center in Lebanon. Medicine (Baltimore) 2023; 102:e35194. [PMID: 37773845 PMCID: PMC10545388 DOI: 10.1097/md.0000000000035194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/22/2023] [Indexed: 10/01/2023] Open
Abstract
Presentations to the emergency department (ED) are growing worldwide. With the increasing risk factors of non-communicable disease (NCD) and communicable diseases (CD) in low- and middle-income countries, it is crucial to understand how ED presentations are changing with time to meet patients' needs and allocate acute care resources. The aim of this study is to compare the changes in patient and diseases characteristics over 2 time periods 10 year apart at the largest tertiary care center in Lebanon. This was a retrospective descriptive study of patients presenting to the ED at a large tertiary care center in 2009/2010 and 2018/2019. The discharge diagnoses were coded into Clinical Classification Software codes. We used descriptive statistics, odds ratios (OR), and non-parametric test to compare the different diagnoses. The total number of ED visits increased by 33% from 2009/2010 to 2018/2019. The highest increase rate was among patients older than 65 years (2.6%), whereas the percentage of pediatric patients decreased from 30.8% to 25.3%. ED presentations shifted from NCD to CD. A shift in the discharge diagnoses was also noted within age groups, specifically a shift in cardiovascular diseases to a younger age. Our study suggests that the role of the ED is changing and moving towards treating the aging population and CD. There is a need to invest and mitigate CD, better allocate resources to accommodate the aging population, focus on awareness campaigns targeting early detection of cardiovascular diseases and modifying its risk factors.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lara Ghandour
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Najat Saliba
- Department of Chemistry, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Cardenas S, Scolnik D, Jarvis DA, Thull-Freedman J. Impact of a 1-Year Pediatric Emergency Medicine Training Program for International Medical Graduates. Pediatr Emerg Care 2022; 38:273-278. [PMID: 35507369 DOI: 10.1097/pec.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Hospital for Sick Children in Toronto has offered a 1-year subspecialty residency training program in pediatric emergency medicine (PEM) to Canadian and internationally trained pediatricians and emergency physicians since 1993. The program is intended to support clinical service delivery while simultaneously offering a unique educational opportunity to Canadian and international physicians who desire 1 year of clinically focused training. We describe the experiences and career outcomes of participants who completed this program. METHODS Two surveys were sent to the 68 individuals who completed the clinical fellowship program from its inception in 1993 until 2014. A blinded survey focused on the fellowship experience and subsequent career activities. A nonblinded survey subsequently determined whether participants had served as a medical director or training program director. RESULTS Sixty of the 68 participants (88%) completed the blinded survey. Ninety-one percent were in practice in emergency medicine. Twenty-five percent of the participants were living in Canada, compared with 17% before completing the program. This net migration of 8% was not significant (P = 0.26). Thirty-six of the 50 participants (72%) who applied from outside Canada responded to the nonanonymous survey; 18 (50%) had served as an emergency department medical director, and 18 (50%) reported serving as a PEM training program director. CONCLUSIONS Many participants attained leadership positions in PEM in countries outside of North America and/or participated in training program development. There was no significant change in the proportion of participants living in North America at the time of application compared with the time of survey completion.
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Affiliation(s)
- Sandra Cardenas
- From the Department of Paediatrics, School of Medicine and Health Sciences TecSalud ITESM, Monterrey, Mexico
| | - Dennis Scolnik
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - D Anna Jarvis
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Al-Qahtani MH, Yousef AA, Awary BH, Albuali WH, Al Ghamdi MA, AlOmar RS, AlShamlan NA, Yousef HA, Motabgani S, AlAmer NA, Alsawad KM, Altaweel FY, Altaweel KS, AlQunais RA, Alsubaie FA, Al Shammari MA. Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia. BMC Emerg Med 2021; 21:72. [PMID: 34154525 PMCID: PMC8215860 DOI: 10.1186/s12873-021-00467-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Background The Emergency Room (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.
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Affiliation(s)
- Mohammad H Al-Qahtani
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Abdullah A Yousef
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Bassam H Awary
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Waleed H Albuali
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia.
| | - Nouf A AlShamlan
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Haneen A Yousef
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Sameerah Motabgani
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Naheel A AlAmer
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Kawthar M Alsawad
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Y Altaweel
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Kawther S Altaweel
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Roaya A AlQunais
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Fatima A Alsubaie
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Malak A Al Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
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Giri S, Halvas-Svendsen T, Rogne T, Shrestha SK, Døllner H, Solligård E, Risnes K. Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality. Glob Pediatr Health 2020; 7:2333794X20947926. [PMID: 32995370 PMCID: PMC7502999 DOI: 10.1177/2333794x20947926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background. In low-income countries, pediatric emergency care is largely underdeveloped although child mortality in emergency care is more than twice that of adults, and mortality after discharge is high. Aim. We aimed at describing characteristics, triage categories, and post-discharge mortality in a pediatric emergency population in Nepal. Methods. We prospectively assessed characteristics and triage categories of pediatric patients who entered the emergency department (ED) in a local hospital. Patient households were followed-up by telephone interviews at 90 days. Results. The majority of pediatric emergency patients presented with injuries and infections (~40% each). Girls attended ED less frequent than boys. High triage priority categories (orange and red) were strong indicators for intensive care need and for mortality after discharge. Conclusion. The study supports the use and development of a pediatric triage systems in a low-resource general ED setting. We identify a need for interventions that can reduce mortality after pediatric emergency care. Interventions to reduce pediatric emergency disease burden in this setting should emphasize prevention and effective treatment of infections and injuries.
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Affiliation(s)
- Samita Giri
- Norwegian University of Science and Technology, Trondheim, Norway.,Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | - Tormod Rogne
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Henrik Døllner
- Norwegian University of Science and Technology, Trondheim, Norway.,St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Solligård
- Norwegian University of Science and Technology, Trondheim, Norway.,St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kari Risnes
- Norwegian University of Science and Technology, Trondheim, Norway.,St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Ijaz N, Strehlow M, Wang NE, Pirrotta E, Tariq A, Mahmood N, Mahadevan S. Correction to: Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan. BMC Emerg Med 2020; 20:66. [PMID: 32859173 PMCID: PMC7453707 DOI: 10.1186/s12873-020-00364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nadir Ijaz
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm M121, Alway Building MC 5119, Stanford, CA, 94305, USA
| | - Matthew Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm M121, Alway Building MC 5119, Stanford, CA, 94305, USA.
| | - N Ewen Wang
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm M121, Alway Building MC 5119, Stanford, CA, 94305, USA
| | - Elizabeth Pirrotta
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm M121, Alway Building MC 5119, Stanford, CA, 94305, USA
| | - Areeba Tariq
- Honors Program in Medical Education, Northwestern University, Evanston, IL, USA
| | - Naseeruddin Mahmood
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Swaminatha Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Rm M121, Alway Building MC 5119, Stanford, CA, 94305, USA
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Lahmini W, Bourrous M. Mortality at the pediatric emergency unit of the Mohammed VI teaching hospital of Marrakech. BMC Emerg Med 2020; 20:57. [PMID: 32703150 PMCID: PMC7376937 DOI: 10.1186/s12873-020-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/09/2020] [Indexed: 12/04/2022] Open
Abstract
Background The death of a child at the emergency ward is one of the most difficult problems that the clinicians of these wards have to deal with. In our country the published data concerning the causes and the factors related to pediatric mortality especially in the pediatric emergency wards is very rare. This study aimed to study the epidemiology of the pediatric mortality in the pediatric emergency department (PED), to determine its rate and identify its most frequent causes. Methods It is a retrospective and descriptive study, over five years (1st January 2012 and 31st December 2016) including all children aged from 0 to 15 years old who died at the PED in the Mohamed VI Hospital in Marrakech. Results During the period of the study a total of 172.691 patients presented to the PED, among which 628 died (pediatric mortality rate: 3.63%). The masculine gender was predominant (n = 383) with a gender ratio of 1.59. Two-thirds of the patients died in the first 24 h (n = 421). The median of time from admission to death was around 12 h. Majority of the deceased children (n = 471, 75%) were from a low socioeconomic status. The most frequent cause of admissions for deceased patients in the PED was respiratory distress (n = 296, 47%) followed by neurological disorders (n = 70, 11%). Neonatal mortality (≤ 1 month of age) was predominant (n = 472, 75.1%), followed by postnatal mortality (1 month to 1 year old) (n = 73, 11.6%). The most frequent causes of pediatric mortality, whatever the age range, were dominated by neonatal pathologies (n = 391, 62.3%), followed by infecious causes bronchopulmonary infections included (n = 49, 7.7%), birth deformities (n = 46, 7.3%) while traumas were merely at 0.9% (n = 6). The most frequent causes of neonatal mortality were neonatal infections (n = 152, 32.2%) and prematurity (n = 115, 24.4%). Conclusion Our data once again underline the crucial importance of prevention. This requires correct follow-up of the pregnancies, an adequate assistance of births, and perfecting healthcare provision to newborns in order to attain proper assistance.
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Affiliation(s)
- W Lahmini
- Department of Paediatric Emergency, UHC Mohamed VI, Cadi Ayyad University, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco
| | - M Bourrous
- Department of Paediatric Emergency, UHC Mohamed VI, Cadi Ayyad University, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco.
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