Research methodology

Research methodology

FACTORS ASSOCIATED WITH POOR PROGNOSIS IN PEDIATRIC COMA CASES AT THE ACUTE CARE UNIT OF MULAGO NATIONAL REFERRAL HOSPITAL

ABBREVIATIONS

• MNRH – Mulago National Referral Hospital
• CM – Cerebral Malaria
• ABM – Acute Bacterial Meningitis
• ICU – Intensive Care Unit
• RPCs – Resource-Poor Countries
• NTC – Non-Traumatic Coma
• GCS – Glasgow Coma Scale
• CNS – Central Nervous System
• SID – Sudden Infant Death
• UNICEF – United Nations Children’s Emergency Fund
• WHO – World Health Organization
• UMoH – Uganda Ministry of Health
• SUPPORT – Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment
• A&E – Accident and Emergency

CHAPTER ONE: INTRODUCTION

This chapter outlines the background, problem statement, study objectives, research questions, and justification for the research.

1.1 Background

Globally, significant progress has been made in reducing child mortality, with pediatric deaths declining by 62% between 1990 and 2016 (WHO, 2017). However, pediatric coma remains a leading cause of child mortality and disability, accounting for 62% of Sudden Infant Deaths (SID), often occurring within three hours of onset without prompt intervention (UNICEF, 2012).

The primary causes of poor prognosis in pediatric coma include preterm birth complications, pneumonia, birth asphyxia, diarrhea, and malaria. In Pakistan, weak healthcare systems contribute to high child mortality, with 420,000 deaths reported in 2016 alone (WHO, 2017). Similarly, Sub-Saharan Africa continues to face challenges in pediatric care, with neonatal deaths remaining stagnant between 1990 and 2016. Achieving the Sustainable Development Goal (SDG) target of 12 neonatal deaths per 1,000 live births by 2030 remains a challenge for 52 countries (WHO, 2016).

In Kenya, child mortality has decreased but remains high at 49.2 deaths per 1,000 live births (2016), attributed to malaria, non-communicable diseases, and malnutrition—particularly in regions like Turkana, where 73,000 children suffer from malnutrition (Kenya Demographic Health Survey, 2016).

Pediatric coma can be traumatic or non-traumatic, presenting high risks of mortality and long-term disability. Early detection is critical, and several coma scales (e.g., Glasgow Coma Scale) are used to assess consciousness levels in children (Luban et al., 2013).

Coma is a medical emergency, requiring rapid diagnosis and intervention to prevent fatal outcomes or long-term complications. The annual incidence of non-traumatic coma is 30 per 100,000 children, while traumatic brain injuries occur at 670 per 100,000 children (Ibekwe et al., 2011).

1.2 Problem Statement

Pediatric coma mortality rates are significantly higher in low-income countries compared to developed nations. In Sub-Saharan Africa, deaths decreased from 230,000 in 1990 to 150,000 in 2012 (WHO, 2013).

In Uganda, approximately 2,800 children die annually from pediatric coma, with higher mortality rates in public hospitals compared to private facilities like Nsambya Hospital, which recorded only 17 deaths in 2010 (UMoH, 2012).

At MNRH’s Acute Care Unit, 1,149 pediatric cases are seen monthly. Between April and December 2018, 127 children were admitted to the ICU with coma, resulting in 61 deaths out of 168 total fatalities in the ward.

Despite Uganda’s 2015/2016 recruitment of 3,000 additional health workers (including doctors, nurses, and anesthetists) to improve pediatric and maternal care, poor prognosis persists in coma cases at MNRH. This study seeks to investigate the underlying factors contributing to these outcomes.

1.3 Study Objectives

1.3.1 Broad Objective

To determine the factors contributing to poor prognosis in pediatric coma cases at MNRH’s Acute Care Unit.

1.3.2 Specific Objectives

1. To assess the socioeconomic factors influencing poor prognosis in pediatric coma.
2. To evaluate health facility-based factors affecting outcomes in pediatric coma cases.

1.4 Research Questions

1. What socioeconomic factors contribute to poor prognosis in pediatric coma at MNRH?
2. What health facility-related factors affect prognosis in pediatric coma cases at MNRH?

1.5 Justification of the Study

This research will:

• Raise awareness on pediatric coma management and prevention strategies.
• Inform policymakers and healthcare providers on gaps in care that need improvement.
• Guide future research on pediatric coma outcomes in resource-limited settings.
• Contribute to reducing mortality and improving rehabilitation for coma-affected children.