An Evaluation of Clinical Indicators for Severe Paediatric Illness

ABSTRACT

To help reduce paediatrict morbidity and mortality in the developing world; WHO has developed a diagnostic and treatment algorithm that targets the principle causes of death in children; which include acute respiratory infection; malaria; measles; diarrhoea disease; and malnutrition. With this algorithm; known as the Sick Child Charts; severely ill children are rapidly identified; through the presence of any one of 13 signs indicative of severe illness; and referred for more intensive health care. These signs are the inability to drink; abnormal mental status (abnormally sleepy); convulsions; wasting; oedema; chest wall retraction; stridor; abnormal skin turgor; repeated vomiting; stiff neck; tender swelling behind the ear; pallor of the conjunctiva; and corneal ulceration. The usefulness ofthese signs; both in current clinical practice and within the optimized context of the Sick Child Chart algorithm in a rural district of Western Kenya; was evaluated. We found that 27of the children seen in outpatient clinics had one or more of these signs and that pallor and chest wall retraction were the signs most likely to be associated with hospital admission (odds ratio(OR)=8.6 and 5.3; respectively). Presentation with any of these signs led to a 3.2 times increased likelihood of admission; although 54of hospitalized children had no signs and 21of children sent home from the outpatient clinic had at least one sign. Among inpatients; 58of all children and 89of children who died had been admitted with a sign. Abnormal mental status was the sign most highly associated with death(OR=59.6);followed by poor skin turmor(OR=5.6);pallor(OR=4.3);repeated vomiting(OR=3.6); chest wallretraction (OR=2.7);and oedema (OR=2.4). Overall;the mortality risk associated with having at least onesign was 6.5 times higher than that for children without any sign. While these signs are useful in identifying a subject of children at high risk of death; their validationin other settings is needed. The training and supervision of health workers to identify severely ill children should continue to be given high priolity because of the benefits; such as reduction of childhood mortality