In 2017, 50% of deaths of children under 5 years old worldwide occurred in sub-Saharan Africa, one in 13 children died before their fifth birthday [1]. Most of these deaths are due to preventable causes such as birth complications, pneumonia, diarrhea, neonatal sepsis and malaria. After the age of 5 years more deaths occur as a result of trauma, mainly caused by drowning and road accidents, children residing in sub-Saharan Africa were 15 times more likely to die than European children [1]. In 2018 in Cameroon, the infant mortality quotient was estimated at 48/1000 [2]. Although emergency medicine is poorly developed in resource-limited setting, visits to emergency departments have increased dramatically in recent years. The Center of Disease Control (CDC) reports an increase of over 35% in emergency room visits in the USA in 2009 compared to 1996 [3]. In France in 2014, the use of emergency services in general would have doubled in 10 years [4]. In previous studies in Africa, infectious pathologies were often found in children under 5 years of age consulting at pediatric emergencies, malaria being the most common etiology. Pediatric emergency unit mortality rates ranged from 8% to 17.3% [5] [6] [7]. Few studies have been conducted on critical pediatric emergencies in a resource-limited setting, especially in Cameroon where no studies were available. To improve mortality due to critical pediatric emergencies, the objective of this work was to describe the epidemiological profile of children with life-threatening emergencies on admission and their evolution.

We obtained research authorization No. 0647 of March 01, 2017 from Laquintinie Hospital Douala and ethical clearance from the ethics committee of the University of Douala No. 881/16/2017 /T. Data was collected anonymously and was used only for research purposes

Of the 318 patients who were admitted at the pediatric emergency department of the LHD during the study period, 135 patients presented with a life-threatening emergency, giving us hospital prevalence of life-threatening emergencies of 42.4%. More than 4/5 of emergencies were neurological, 35.6% respiratory emergencies and 18.5% cardio-circulatory emergencies (Figure 1).

Our work focused on the epidemiological profile of pediatric life-threatening emergencies (PLTE) and the short-term evolution of patients admitted to the pediatric department at Laquintinie Hospital in Douala. The hospital prevalence of pediatric life-threatening emergencies was 42.4%. Nzame et al., in Gabon (2020), Guedenon et al. in Togo (2017) and Kingwengwe et al. in DRC (2019), had reported a prevalence of PLTE which varied from 18.3% to 21.4% in their respective previous studies [7] [8] [9].

The high trend in our series could be explained by the geographical location of this referral hospital which has a technical platform to receive patients with serious pathologies on the one hand and on the other hand, access to care is facilitated through the issuance of internal vouchers (green vouchers) with deferred recovery of care costs. In our study, 60.0% of fathers were informal sector workers and 46.7% of mothers were unemployed. A similar trend of precarious employment or parental unemployment reflecting a low socio-economic level was also observed by Fatou Ly in Senegal (2016) [10]. More than 3 out of 5 children in our study were male and the sex ratio was 1.54. This result was similar to those found by Nzameet al. in Gabon, Ly Fatou in Senegal in 2016 and Asse et al., in Ivory Coast (2012). This was unlike results by Enyuma et al. in Nigeria (2014) which had found a female predominance [8] [10] [11] [12]. The mean age of the patients was 3.80 years, and children under 5 years of age accounted for 80.7% of patients. This distribution was lower than that found by Guedenon in Togo and higher than that reported in Gabon, Senegal and Morocco, whose proportions varied from 68.8% to 72.7% [8] [9] [10] [13]. The vulnerability to infections, the rapid evolution and the early complications of childhood illnesses common in this age group could explain this situation.

More than 3/4 of patients admitted for life-threatening emergencies came from a peripheral hospital structure and only 17.0% came from their homes. These results were similar to those reported by Roukia et al. in Morocco (2019), where 61.2% came from other peripheral health facilities unlike previous studies carried out in Senegal, in Benin and in Cameroon where the majority of patients came from their homes [10] [11] [14] [15]. The reasons given for their choice and the therapeutic course are the perception of the mild disease by the parents at the onset of the symptoms while the persistence and severity of the disease were the main reasons why they ended up going for consultation in health facilities according to Ndukwu et al. in Nigeria (2015) [16]. Before arriving at the pediatric emergency department at HLD, 87.4% of patients had received previous treatment. These results were superior to those reported by Penda et al. in Cameroon (2017), and Enyuma et al. where 74.1% and 50.7% had received self-medication before admission to the pediatric emergency unit, respectively [12] [15]. The mean time to consultation after the onset of the disease was 6.0 days and more than 3/5 of the patients with PLTE were admitted between 3 p.m. - 7:59 a.m. This delay was greater than that found by Penda et al., However it was multiplied by three in the series reported by Ndukwu et al. [15] [16]. The long therapeutic course of sick children leads to a delay in consultation due to the underestimation of the severity of the disease by the parents, and ultimately lead to the delay in the diagnosis of emergency situations or complications in downstream health structures. These situations would be detrimental to the survival of the child. Regarding admission times, our results were consistent with those of Enyuma et al. and Fatou Ly et al. where life-threatening emergencies were mostly received during on-call hours [10] [12]. The most frequent reasons for consultation were seizures, dyspnea and fever. These data were comparable to that found by previous studies [6] [8] [12] [13] [17]. More than 3 in 4 patients with PLTE were treated within 30 minutes of admission. This trend is higher than that reported by other authors [8] [10]. This early management could be explained by the measures put in place in the service to overcome the delay in management with the use of an internal voucher (green voucher) with deferred care cost recovery and local emergency kits. Neurological pediatric life-threatening emergencies dominated the picture with convulsions and comas, followed by respiratory and cardio-circulatory emergencies. These results were comparable to those found by El Gajoui et al. in Morocco (2017) but in different proportions because the respiratory emergencies accounted for nearly half of the cases (45.3%) followed by neurological (25.1%), and cardio circulatory (20.7%) emergencies [19].

The spectacular clinical presentation of the convulsions and respiratory distress could explain the more numerous urgent consultations in our series. The vulnerability of children to these pathologies is thought to be one of the causes of the early development of this type of complications. Severe malaria was the primary etiology of PLTE, as similarly reported by several previous studies [5] [7] [11] [12] [15] - [20]. These results confirm that severe malaria remains the leading cause of morbidity, particularly in children aged 0 - 5 years. In general, infectious pathologies dominate the table of etiologies of vital emergencies in our sample. Pulmonary infectious pathologies took second place and can be compared to the results of Ejlaidi et al. and Enyuma et al. in Nigeria, where the frequencies of respiratory infections and malaria were comparable (53.7% and 52.4% respectively) [12] [13]. The average length of emergency hospital stay was 2.7 days (min-max: 1 - 44 days), Enyuma et al. reported a similar trend in their study in Nigeria [12]. In our series, the pediatric emergency unit received patients until their stabilization. The average length of stay in the pediatric emergency room was 2.7 days (min-max: 1 - 44 days), Enyuma et al. reported a similar trend in their study in Nigeria [12]. In our series, the intensive care unit received patients until their stabilization. The death rate from life-saving emergencies was 17.8%. The number of deaths from life-threatening emergencies accounted for more than half (61.5%) of the 39 deaths recorded in the pediatric emergency department. A similar trend was found by Kingwengwe in DRC and Guedenon in Togo [7] [9], lower than that found by Edulu et al. in Nigeria but higher in the series of El Gajoui in Morocco [18] [19]. In all these series, mortality more particularly concerned children under 5 years old. These results highlight their great vulnerability to infections at this age.

Almost half of the children admitted to pediatric emergencies had a life-threatening emergency. The profile of a life-threatening pediatric emergency is that of a boy, less than 5 years old, coming from a peripheral health facility after having received previous treatment. Infectious pathologies dominated the etiological profile. The very high mortality of life-threatening emergencies could be avoided by setting up staff capacity building, the technical platform and innovative strategies to facilitate the care of patients at a low socio-economic level in our context of limited resources.

We thank the staff of the pediatric emergency department at Laquintinie Hospital for their support in this work as well as all the people who contributed to the success of the work

CIP, DKKM and MKL contributed in the conception of this work. CIP, MKL, EBB contributed for data collection and analysis. CIP, EMLM and SBF conceived and wrote the draft manuscript. CIP, SBF, EEC, EMLM and DKKM contributed in proofreading the manuscript.

The authors declare no conflicts of interest regarding the publication of this paper.

Ida, P.C., Mireille-Laurent, E.M., Francine, S.B., Lariale, M.K.K., Charlotte, E.E., Bertrand, E.B. and Danièle, K.K. (2021) Epidemiological Profile of Pediatric Vital Emergencies at Laquintinie Hospital of Douala, Cameroon. Open Journal of Pediatrics, 11, 148-160. https://doi.org/10.4236/ojped.2021.111014