Characteristics and health insurance profile of brought-in-dead children in a rural tertiary hospital

Background: Despite the regular occurrence of brought-in-dead (BID) phenomenon, little is known about their prevalence, pattern and prehospital contributors in rural settings in Nigeria. In addition, the impact of health insurance in this context has not been described in our locale. Our study aimed at identifying the characteristics and access to health insurance of paediatric BID cases.

Design: A cross-sectional, retrospective study in the paediatric emergency department of a rural tertiary hospital.

Methods: Data were obtained from the medical records of BID cases from January 2019 to December 2023. Their sociodemographic details, the nature and duration of preceding illnesses/complaints, prior treatment, referral and health insurance types were obtained.

Results: Sixty-seven (1.38%) of the 4872 admissions were BID. Their ages ranged between 12 hours and 14 years with a male:female ratio of 1.1:1. Forty-four (69.84%) were under 5s. Acute encephalitis syndrome, gastroenteritis and sepsis/severe malaria were the most prevalent presumed causes of death. Prior to arrival, 30.56% had obtained treatment outside the hospital setting (medicine vendors, herbal treatment, home nurse and religious centres). Almost half of the referrals were informal referrals by family and neighbours. None (0%) presented health insurance records nor was brought in by an ambulance.

Conclusion: Infectious diseases were the most common presumed causes of death and under 5s bore the greatest burden of BID. The healthcare choices were poor, but the informal sociocultural support system was strong. There was a dearth of health insurance enrolment, a poor patient referral and transfer system, and poor documentation of BID cases. We identify the need for concerted health education, improved patient referral and transfer, well-coordinated death registration and appropriate health insurance schemes in rural communities.