{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:05:04Z","timestamp":1789178704076,"version":"build-2803163510"},"reference-count":52,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["Grant OPP 1148892"],"award-info":[{"award-number":["Grant OPP 1148892"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,7,19]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>3850 children 0\u201314 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1\u2009month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age &lt;28\u2009days) was associated with increased odds of death (OR 4.34 [95% CI 2.38 to 8.18], p&lt;0.001, reference age 28 days\u201314 years) and there was no significant difference in odds of death between female vs male children (OR 1.12, 95%\u2009CI 0.6 to 2.04, p=0.72). 47 children died in the hospital (3.6%) and three (0.2%) died within 28 days of admission. Most children who died were &lt;28\u2009days old (n=32\/50, 64%); leading diagnoses included neonatal sepsis\/meningitis (n=13\/50, 26%), neonatal encephalopathy (n=7\/50, 14%) and lower respiratory tract infections (n=6\/50, 12%). Delays in care-seeking (n=15) and in receiving appropriate treatment (n=12) were common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study adds to sparse literature surrounding the epidemiology of disease and hospital outcomes for children with acute illness seeking healthcare in rural Pakistan and, in particular, among children aged 5\u201314 years. Further studies should include public and private hospitals within a single region to comprehensively describe patterns of care-seeking and interfacility transfer in district health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082255","type":"journal-article","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T01:07:30Z","timestamp":1724375250000},"page":"e082255","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["The spectrum of acute illness and mortality of children and adolescents presenting to emergency services in Sanghar district hospital, Pakistan: a prospective cohort study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-4142","authenticated-orcid":false,"given":"Fiona","family":"Muttalib","sequence":"first","affiliation":[{"name":"Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, 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