Risk factors associated with presence of general danger signs in children who present with acute severe illness at Kenyatta National Hospital
Back ground: Every year about 7 million children die before their 5th birth day. Most of these deaths occur in developing countries. These deaths result from a disease or a combination of diseases that can be prevented or treated by existing inexpensive interventions. The leading causes of child deaths are; acute respiratory infections (18%), diarrhea (11%), malaria (7%), measles (1%), and malnutrition increases the risk of dying from these diseases. Since most of these deaths occur in developing countries compared to developed countries, understanding the risk factors of the severe forms of illnesses may help in planning interventions for controlling childhood morbidity and mortality. Objective: To determine the risk factors associated with presence of general danger signs in children who present with acute severe illness at Kenyatta National Hospital. Methodology: This was a hospital-based, case-control study, carried out at the Kenyatta National Hospital Paediatrics Emergency Unit. Children aged 2-59 months presenting at Kenyatta National Hospital with signs and symptoms of acute severe illness were recruited, of whom one hundred and forty two were cases and one hundred and forty two were controls. Children were selected daily and enrolled after getting a written informed consent from their caregivers. Data were checked for completeness, entered into Microsoft excel data sheet, cleaned and exported to SPSS statistical package for analysis. Frequencies, means and proportions were calculated. To compare means student t-test was used. Statistical significance was taken at the level p < 0.05 and odds were calculated using both univariate and multivariate analysis. Results: A total of 142 cases with general danger signs and 142 controls were included in the study. Cases were slightly older than controls, their mean age in months being 14.16 (SD±11.83) versus 12.68 (SD±10.3) respectively. Using multivariate logistic regression analysis, risk factors independently associated with presence of general danger signs were; use of biomass as the source of cooking fuel OR=3.38 (95% CI=1.41-8.06), P=0.006, severe pneumonia OR 5.2(95% CI=3.0-9.2), P=<0.001, having more than one diagnosis in a child OR=3.68 (95% CI=2.00-6.77), P= <0.001, and presentation to hospital for treatment later than 3 days of symptoms onset OR=1.32 (95% CI=1.14-1.53), P=<0.001. Conclusion: This study shows that socioeconomic factors such as use of biomass as cooking fuel source is associated with presence of general danger signs in children with acute severe illness. Severe pneumonia and having more than one diagnosis in a child were the clinical factors associated with presence of general danger signs. Presentation to hospital for treatment later than 3 days was also associated with presence of general danger signs. Recommendation: Use of cleaner fuels such as natural gas and electricity is recommended over biomass. Integrated approach to management of children who present with general danger signs is of utmost importance to deal with the multiple illnesses and there is need to educate parents/caregivers and communities about simple signs of diseases that suggest a need for seeking professional medical attention.