PEDIATRIC ADMISSIONS TO A RURAL SOUTH-AFRICAN HOSPITAL - VALUE OF HOSPITAL DATA IN HELPING TO DEFINE INTERVENTION PRIORITIES AND ALLOCATE DISTRICT RESOURCES

Objective. To audit paediatric medical admissions to a rural district hospital in order to help define intervention priorities and allocate district resources. Design. Prospective audit of consecutive admission s to the paediatric medical service of Hlabisa Hospital, KwaZulu-Natal , between March 1995 and February 1996. Main outcome measures. Number of admissions, month of admission, age, sex, diagnosis, nutritional st atus, HIV status, outcome and length of stay. Results, Of 1 364 childr en admitted, 995 (73%) were aged under 24 months and 584 (43%) were ei ther underweight for age or severely malnourished. Acute respiratory t ract infection (384, 28%), acute diarrhoea (200, 15%), dysentery (168, 12%) and severe malnutrition (149, 11%) were the major causes for adm ission and were responsible for most deaths (113, 75%), The overall ca se fatality rate was 11% and most (90, 60%) died within 48 hours of ad mission. Forty-five per cent of the 332 children tested were HIV-posit ive. Conclusion. Most severe morbidity and mortality result from four common conditions, reflecting poor socioeconomic conditions in the are a. Opportunities for clincial intervention to reduce their impact incl ude identification of 'at risk' children, focusing care early in admis sions, use of standardised protocols of care, and integrated managemen t of the sick child.