Moïsi, Jennifer C; Gatakaa, Hellen; Berkley, James A; Maitland, Kathryn; Mturi, Neema; Newton, Charles R; Njuguna, Patricia; Nokes, James; Ojal, John; Bauni, Evasius; +5 more... Tsofa, Benjamin; Peshu, Norbert; Marsh, Kevin; Williams, Thomas N; 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, 89 (10). 725-732A. ISSN 0042-9686 DOI: https://doi.org/10.2471/BLT.11.089235
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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 over time. 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 | Article |
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Faculty and Department |
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology Faculty of Public Health and Policy > Dept of Global Health and Development |
PubMed ID | 22084510 |
ISI | 295707700010 |
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