Childhood dead-before-arrival, our experience at a tertiary hospital in Southern Nigeria: a clarion call to stakeholders in the health sector

Dead-Before-Arrival (DBA) is a term used to describe patients who have no sign of life at the time of presentation to the hospital. There is a dearth of information about this cohort of children at most healthcare service delivery points. In fact, these children are also never captured in most of our national and local healthcare data. This research is aimed at sharing our experience on DBA at the Children’s Emergency Room of a tertiary hospital in the South-South geopolitical region of Nigeria, by determining the prevalence, probable disease cause, and pattern of DBA among children presenting at our facility. This is a cross-sectional study that used a standardized verbal autopsy instrument to ascertain the details of all the children aged 1 month to 17 years who were cases of DBA at the Children’s Emergency Room of the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria, over 24 months (January 2018 to December 2019). Socio-demographic characteristics, symptoms before demise, treatment received, and suspected cause(s) of death were documented. The prevalence of DBA was compared to the in-hospital mortality during the period. A total of 96 (3.2%) compared to 144 (4.9%) in-hospital of the 2,914 emergency admissions were cases of DBA, with a 2:1 male-to-female ratio. The age group of 1-6 months had the highest proportion (41.7%). Children under two were 62.5% and 81.3% were under-fives. Infections such as diarrhea, bronchopneumonia, and sepsis were the most common suspected causes of death, followed by non-infectious causes such as perinatal asphyxia, Chronic Kidney Disease (CKD), cyanotic congenital heart disease, drowning, and electrocution. Cases of DBA were significantly lower than in-hospital mortality (144 cases) during the study period (3.2% vs 4.9%) The DBA prevalence as recorded in this hospital-based study may be the tip of the iceberg compared to what happens in the community. Making our primary and secondary health care services more accessible, affordable, and optimally functional may help reduce the burden of DBA.