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Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis
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Moïsi, Jennifer, Gatakaa, Hellen, Berkley, James A., Maitland, Kathryn, Mturi, Neema, Newton, Charles, Njuguna, Patricia, Nokes, D. James, Ojal, John, Bauni, Evasius, Tsofa, Benjamin, Peshu, Norbert, Marsh, Kevin, Williams, Thomas and Scott, J. Anthony G. (2011) Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis. Bulletin of the World Health Organization, Vol.89 (No.10). pp. 725-732. doi:10.2471/BLT.11.089235
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Official URL: http://dx.doi.org/10.2471/BLT.11.089235
Abstract
Objective
To explore excess paediatric mortality after discharge from Kilifi District Hospital, Kenya, and its duration and risk factors.
Methods
Hospital and demographic data were used to describe post-discharge mortality and survival probability in children aged < 15. years, by age group and clinical syndrome. Cox regression models were developed to identify risk factors.
Findings
In 2004-2008, approximately 111 000 children were followed for 555 000 person years. We analysed 14 971 discharges and 535 deaths occurring within 365 days of discharge. Mortality was higher in the post-discharge cohort than in the community cohort (age-adjusted rate ratio, RR: 7.7; 95% confidence interval, CI: 6.6-8.9) and declined little overtime. An increased post-discharge mortality hazard was found in children aged <5 years with the following: weight-for-age Z score <-4 (hazard ratio, HR: 6.5); weight-for-age Z score > -4 but < -3 (HR: 3.4); hypoxia (HR: 2.3); bacteraemia (HR: 1.8); hepatomegaly (HR: 2.3); jaundice (HR: 1.8); hospital stay > 13 days (HR: 1.8). Older age was protective (reference < 1 month): 6-23 months, HR: 0.8; 2-4 years, HR: 0.6. Children with at least one risk factor accounted for 545 (33%) of the 1655 annual discharges and for 39 (47%) of the 83 discharge-associated deaths.
Conclusion
Hospital admission selects vulnerable children with a sustained increased risk of dying. The risk factors identified provide an empiric basis for effective outpatient follow-up.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Subjects: | Q Science > Q Science (General) | ||||
| Divisions: | Faculty of Science > Life Sciences (2010- ) | ||||
| Journal or Publication Title: | Bulletin of the World Health Organization | ||||
| Publisher: | World Health Organization | ||||
| ISSN: | 0042-9686 | ||||
| Official Date: | 2011 | ||||
| Dates: |
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| Volume: | Vol.89 | ||||
| Number: | No.10 | ||||
| Number of Pages: | 8 | ||||
| Page Range: | pp. 725-732 | ||||
| DOI: | 10.2471/BLT.11.089235 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
| Funder: | Wellcome Trust (UK) , Wellcome Trust | ||||
| Grant number: | 081835, 083579, 076934, (WT) |
Data sourced from Thomson Reuters' Web of Knowledge
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