title: Persisting high hospital and community childhood mortality in an urban setting in Guinea-Bissau.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Projecto de Saúde de Bandim, Apartado 861, Bissau, Guinea-Bissau.
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Veirum
authors.forename: Sidu
authors.initials: S
authors.lastname: Biai
authors.forename: Marianne
authors.initials: M
authors.lastname: Jakobsen
authors.forename: Anita
authors.initials: A
authors.lastname: Sandström
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hedegaard
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Kofoed
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: Morten
authors.initials: M
authors.lastname: Sodemann
mesh_terms: D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D006169:Guinea-Bissau; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D015397:Program Evaluation; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D013997:Time Factors; D014505:Urban Population