Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis
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 c...
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| Format: | Article |
| Language: | English |
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The World Health Organization
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| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862011001000011&lng=en&tlng=en |
| _version_ | 1797288348094562304 |
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| author | Jennifer C Moïsi Hellen Gatakaa James A Berkley Kathryn Maitland Neema Mturi Charles R Newton Patricia Njuguna James Nokes John Ojal Evasius Bauni Benjamin Tsofa Norbert Peshu Kevin Marsh Thomas N Williams J Anthony G Scott |
| author_facet | Jennifer C Moïsi Hellen Gatakaa James A Berkley Kathryn Maitland Neema Mturi Charles R Newton Patricia Njuguna James Nokes John Ojal Evasius Bauni Benjamin Tsofa Norbert Peshu Kevin Marsh Thomas N Williams J Anthony G Scott |
| author_sort | Jennifer C Moïsi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T18:48:02Z |
| format | Article |
| id | doaj.art-1bb66a2a5e3a41ab99a0e7447f94aeef |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T18:48:02Z |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-1bb66a2a5e3a41ab99a0e7447f94aeef2024-03-02T02:11:44ZengThe World Health OrganizationBulletin of the World Health Organization0042-9686891072573210.1590/S0042-96862011001000011S0042-96862011001000011Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysisJennifer C Moïsi0Hellen Gatakaa1James A Berkley2Kathryn Maitland3Neema Mturi4Charles R Newton5Patricia Njuguna6James Nokes7John Ojal8Evasius Bauni9Benjamin Tsofa10Norbert Peshu11Kevin Marsh12Thomas N Williams13J Anthony G Scott14KEMRIKEMRIKEMRIKEMRIKEMRIKEMRIKEMRIKEMRIKEMRIKEMRIMinistry of Public Health and SanitationKEMRIKEMRIKEMRIKEMRIOBJECTIVE: 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.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862011001000011&lng=en&tlng=en |
| spellingShingle | Jennifer C Moïsi Hellen Gatakaa James A Berkley Kathryn Maitland Neema Mturi Charles R Newton Patricia Njuguna James Nokes John Ojal Evasius Bauni Benjamin Tsofa Norbert Peshu Kevin Marsh Thomas N Williams J Anthony G Scott Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis Bulletin of the World Health Organization |
| title | Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis |
| title_full | Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis |
| title_fullStr | Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis |
| title_full_unstemmed | Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis |
| title_short | Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis |
| title_sort | excess child mortality after discharge from hospital in kilifi kenya a retrospective cohort analysis |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862011001000011&lng=en&tlng=en |
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