Table 3.
Hypoxaemia on admission and corresponding case fatality rates and relative odds of death among children (aged <15 years) admitted to 12 secondary-level hospitals in southwest Nigeria over a 2 year period (Nov 2015–Oct 2017 inclusive).
| Cohort / Condition | No. (%) | No. hypoxaemic (%) | Hypoxaemia prevalence (95% CI) | Case fatality rate (95% CI) | Relative odds of death, hypoxaemic vs non-hypoxaemic, OR (95% CI) | |
|---|---|---|---|---|---|---|
| Crude | Adjusted [1] | |||||
| Total | 23,926 (100) | 2667 (100) | 14.1% (13.6–14.6) | 6.0% (5.7–6.3) | 8.4 (7.4–9.6) | 7.9 (7.0–9.0) |
| Neonates <28 days | 7473 (31.2) | 1363 (51.1) | 22.2% (21.2–23.2) | 9.9% (9.3–10.6) | 6.2 (5.2–7.3) | 5.6 (4.5–6.8) |
| Infants 28 days to 1 year | 4619 (19.3) | 543 (20.4) | 15.6% (14.4–16.9) | 5.6% (5.0–6.3) | 8.2 (6.1–11.1) | 7.7 (5.4–11.1) |
| Children 1–4 years | 8060 (33.7) | 537 (20.1) | 8.8% (8.1–9.5) | 3.8% (3.4–4.3) | 8.9 (6.7–11.9) | 7.5 (5.5–10.2) |
| Children 5–14 years | 3671 (15.3) | 220 (8.2) | 7.2% (6.3–8.2) | 3.4% (2.8–4.0) | 9.5 (6.0–14.8) | 7.6 (4.7–12.4) |
| Female | 10,468 (43.7) | 1147 (43.0) | 13.9% (13.2–14.7) | 5.9% (5.5–6.4) | 9.1 (7.5–11.0) | 8.7 (7.2–10.5) |
| Male | 13,436 (56.1) | 1519 (57.0) | 14.3% (13.6–15.0) | 6.0 (5.6–6.4) | 7.9 (6.7–9.4) | 7.3 (6.2–8.7) |
| Government (n = 7) | 14,292 (59.7) | 1507 (56.5) | 14.6% (13.9–15.3) | 5.3% (4.9–5.6) | 8.1 (6.8–9.7) | 8.0 (6.7–9.6) |
| Mission (n = 5) | 9646 (40.3) | 1160 (43.5) | 13.6% (12.9–14.3) | 7.1% (6.6–7.6) | 9.0 (7.5–10.7) | 8.2 (6.5–10.5) |
| Small [2] (n = 5) | 3590 (15.0) | 293 (11.0) | 10.0% (8.9–11.1) | 4.9% (4.2–5.6) | 12.4 (8.5–18.0) | 11.4 (7.8–16.5) |
| Medium [2] (n = 7) | 20,348 (85.0) | 2374 (89.0) | 14.9% (14.3–15.5) | 6.2% (5.9–6.5) | 7.9 (6.9–9.1) | 12.2 (7.9–18.8) |
| Child diagnoses[3] | ||||||
| Total children | 16,453 (100) | 1304 (100) | 10.2% (9.7–10.8) | 4.2% (3.9–4.5) | 9.2 (7.7–11.0) | 7.3 (6.0–9.0) |
| Malaria | 6166 (37.5) | 428 (32.8) | 8.5% (7.7–9.3) | 2.9% (2.5–3.3) | 9.4 (6.6–13.3) | 6.6 (4.6–9.5) |
| AFE | 3526 (21.4) | 412 (31.6) | 15.4% (14.1–16.9) | 8.6% (7.7–9.6) | 7.2 (5.4–9.5) | 6.5 (4.8–8.9) |
| ALRI | 2073 (12.6) | 486 (37.3) | 28.0% (25.9–30.2) | 7.2% (6.1–8.4) | 6.0 (4.0–8.9) | 7.1 (4.6–10.9) |
| Diarrhoea | 2007 (12.2) | 86 (6.6) | 6.1% (4.9–7.5) | 3.8% (3.0–4.7) | 19.3 (10.5–35.0) | 16.2 (7.8–33.6) |
| Sepsis | 5147 (31.6) | 356 (27.3) | 8.7% (7.8–9.6) | 4.7% (4.1–5.3) | 8.6 (6.2–11.8) | 5.9 (4.1–8.3) |
| Seizures | 2081 (12.6) | 238 (18.3) | 14.3% (12.7–16.1) | 7.7% (6.6–8.9) | 6.8 (4.6–10.0) | 6.3 (4.2–9.3) |
| Meningitis/Encephalitis | 521 (3.2) | 75 (5.8) | 17.4% (13.9–21.3) | 14.1% (11.2–17.4) | 4.4 (2.3–8.2) | 4.5 (2.3–8.6) |
| Haemoglobinopathy | 739 (4.5) | 56 (4.3) | 9.1% (6.9–11.6) | 3.4% (2.2–5.0) | 4.8 (1.6–13.1) | 2.9 (0.9–9.2) |
| Malnutrition (SAM) | 324 (2.0) | 45 (3.5) | 18.0% (13.4–23.3) | 16.4% (12.5–20.9) | 6.5 (3.0–14.2) | 14.6 (4.6–46.6) |
| URTI | 680 (4.2) | 37 (2.8) | 6.8% (4.9–9.3) | 1.0% (0–2.1) | 9.8 (0.8–87.7) | – |
| Asthma | 109 (0.7) | 20 (1.5) | 20.4% (12.9–29.7) | 0.9% (0.0–5.0) | – | – |
| Trauma, Burns, Poisoning | 351 (2.2) | 20 (1.5) | 7.1% (4.4–10.8) | 2.0% (0.8–4.1) | 4.5 (0.1–58.5) | – |
| Typhoid | 371 (2.3) | 13 (1.0) | 4.1% (2.2–6.8) | 3.5% (1.9–5.9) | 16.6 (3.0–76.0) | 21.6 (1.9–241.3) |
| HIV | 21 (0.1) | 2 (0.2) | 10.5% (1.3–33.2) | 19.0% (5.4–41.9) | – | – |
| Neonatal diagnoses[4] | ||||||
| Total neonates | 7473 (100) | 1363 (100) | 22.2% (21.2–23.2) | 9.9% (9.3–10.6) | 6.2 (5.2–7.3) | 5.6 (4.5–6.8) |
| Small / Preterm | 1770 (23.7) | 387 (28.4) | 25.8% (23.6–28.1) | 17.5% (15.7–19.3) | 4.3 (3.2–5.7) | 4.6 (3.3–6.3) |
| Small (<2500 g) | 1399 (18.7) | 311 (22.8) | 26.4% (23.9–29.0) | 17.6% (15.7–19.7) | 4.9 (3.5–6.8) | 5.5 (3.8–7.8) |
| - LBW | 1105 (14.8) | 228 (16.7) | 24.3% (21.5–27.1) | 10.8% (9.0–12.7) | 7.1 (4.5–11.2) | 7.7 (4.8–12.6) |
| - VLBW | 231 (3.1) | 58 (4.3) | 30.7% (24.2–37.8) | 32.0% (26.1–38.5) | 2.7 (1.4–5.5) | 3.1 (1.4–6.9) |
| - ELBW | 63 (0.8) | 25 (1.8) | 52.1% (37.2–66.7) | 85.7% (74.6–93.3) | 0.7 (0.1–6.8) | – |
| Preterm (<37 wks) | 1326 (17.7) | 299 (21.9) | 26.6% (24.1–29.3) | 19.6% (17.5–21.9) | 3.5 (2.5–4.7) | 3.6 (2.5–5.1) |
| Neonatal encephalopathy | 2850 (40.4) | 821 (60.2) | 33.4% (31.6–35.3) | 13.2% (12.0–14.5) | 4.1 (3.2–5.3) | 4.2 (3.2–5.6) |
| Neonatal sepsis | 3884 (54.9) | 671 (49.2) | 21.0% (19.6–22.4) | 10.0% (9.0–10.9) | 5.9 (4.6–7.6) | 5.6 (4.2–7.4) |
| Jaundice | 1692 (24.06) | 115 (8.4) | 8.8% (7.3–10.5) | 4.4% (3.5–5.5) | 10.1 (5.8–17.6) | 8.0 (4.0–16.2) |
(1) Adjusted for clustering, time, age, sex, comorbidity, and presence of improved oxygen system using generalised linear mixed model (GLMM); (2) Hospital size: Small - <500 annual paediatric (U/15) admissions; Medium – 500–2500 annual paediatric (U/15) admissions; (3) Malaria, AFE, ALRI, Diarrhoeal, SAM diagnoses based on case definition, other diagnoses based on recorded admission diagnosis; (4) Small and preterm diagnoses based on recorded birthweight and gestation, other diagnoses based on recorded admission diagnosis. AFE = acute febrile encephalopathy (fever on history or examination PLUS altered conscious state or seizures); ALRI = acute lower respiratory infection (cough or difficult breathing PLUS fast breathing for age or lower chest wall in-drawing); Diarrhoea case definition = >3 loose stools per day, not for >14 days duration; ELBW = extremely low birth weight (<1000 g); Hypoxaemia = SpO2 < 90%; LBW = low birth weight (1500–2499 g); Small / Preterm = <2500 g birthweight or <37 weeks gestational age; SAM = severe acute malnutrition (ght-for-height less than −3 z scores of median (WHO growth standards), MUAC<115 mm, or nutritionally-associated oedema (kwashiakor)); URTI = upper respiratory tract infection; VLBW = very low birth weight (1000–1499 g).