Persisting high hospital and community childhood mortality in an urban setting in Guinea‐Bissau

The aim was to describe paediatric hospitalization in a West African capital in relation to overall childhood mortality in the community and to evaluate the potential impact of improved management at the hospital. Hospital data on child admissions in a 6-year period were linked to information in a community-based longitudinal surveillance system. Paediatric hospitalization rates risk factors for hospitalizations community mortality in-hospital mortality and the proportion of deaths occurring at hospital were examined. Almost 15% of infants and 45% of children less than 5 years of age had been hospitalized and 24% of all deaths in the community occurred in-hospital. Community infant and under-three mortality rates were 110 and 207 per 1 000 person-years respectively. In-hospital mortality remained persistently high from 1991 to 1996 and the overall in-hospital mortality was 12%. It was found that wet season lack of maternal schooling and living in a specific district were significant risk factors for both community and in-hospital death whereas higher hospitalization rates were associated with better-off families. In populations with high hospitalization rates even minor improvements in acute case management of sick children attending the hospital would be expected to result in substantial reduction in overall childhood mortality. Persistently high acute in-hospital mortality reflects the need of immediate and appropriate care at the hospital. Treatment should be free of charge in order to minimize the impact of social inequality. (authors)