Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh.
BACKGROUND: Post-discharge mortality among children with severe illness in resource-limited settings is under-recognized and there are limited data. We evaluated post-discharge mortality in a recently reported cohort of children with severe malnutrition and pneumonia, and identified characteristics...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4167196?pdf=render |
| _version_ | 1811220465766629376 |
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| author | Mohammod Jobayer Chisti Stephen M Graham Trevor Duke Tahmeed Ahmed Abu Syed Golam Faruque Hasan Ashraf Pradip Kumar Bardhan Abu S M S B Shahid K M Shahunja Mohammed Abdus Salam |
| author_facet | Mohammod Jobayer Chisti Stephen M Graham Trevor Duke Tahmeed Ahmed Abu Syed Golam Faruque Hasan Ashraf Pradip Kumar Bardhan Abu S M S B Shahid K M Shahunja Mohammed Abdus Salam |
| author_sort | Mohammod Jobayer Chisti |
| collection | DOAJ |
| description | BACKGROUND: Post-discharge mortality among children with severe illness in resource-limited settings is under-recognized and there are limited data. We evaluated post-discharge mortality in a recently reported cohort of children with severe malnutrition and pneumonia, and identified characteristics associated with an increased risk of death. METHODS: Young children (<5 years of age) with severe malnutrition (WHO criteria) and radiographic pneumonia on admission to Dhaka Hospital of icddr,b over a 15-month period were managed according to standard protocols. Those discharged were followed-up and survival status at 12 weeks post-discharge was determined. Verbal autopsy was requested from families of those that died. RESULTS: Of 405 children hospitalized with severe malnutrition and pneumonia, 369 (median age, 10 months) were discharged alive with a follow-up plan. Of these, 32 (8.7%) died in the community within 3 months of discharge: median 22 (IQR 9-35) days from discharge to death. Most deaths were reportedly associated with acute onset of new respiratory or gastrointestinal symptoms. Those that died following discharge were significantly younger (median 6 [IQR 3,12] months) and more severely malnourished, on admission and on discharge, than those that survived. Bivariate analysis found that severe wasting on admission (OR 3.64, 95% CI 1.66-7.97) and age <12 months (OR 2.54, 95% CI 1.1-8.8) were significantly associated with post-discharge death. Of those that died in the community, none had attended a scheduled follow-up and care-seeking from a traditional healer was more common (p<0.001) compared to those who survived. CONCLUSION AND SIGNIFICANCE: Post-discharge mortality was common in Bangladeshi children following inpatient care for severe malnutrition and pneumonia. The underlying contributing factors require a better understanding to inform the potential of interventions that could improve survival. |
| first_indexed | 2024-04-12T07:43:25Z |
| format | Article |
| id | doaj.art-8e72aa86fdc6486d931301a96eb1b0a6 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T07:43:25Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-8e72aa86fdc6486d931301a96eb1b0a62022-12-22T03:41:46ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0199e10766310.1371/journal.pone.0107663Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh.Mohammod Jobayer ChistiStephen M GrahamTrevor DukeTahmeed AhmedAbu Syed Golam FaruqueHasan AshrafPradip Kumar BardhanAbu S M S B ShahidK M ShahunjaMohammed Abdus SalamBACKGROUND: Post-discharge mortality among children with severe illness in resource-limited settings is under-recognized and there are limited data. We evaluated post-discharge mortality in a recently reported cohort of children with severe malnutrition and pneumonia, and identified characteristics associated with an increased risk of death. METHODS: Young children (<5 years of age) with severe malnutrition (WHO criteria) and radiographic pneumonia on admission to Dhaka Hospital of icddr,b over a 15-month period were managed according to standard protocols. Those discharged were followed-up and survival status at 12 weeks post-discharge was determined. Verbal autopsy was requested from families of those that died. RESULTS: Of 405 children hospitalized with severe malnutrition and pneumonia, 369 (median age, 10 months) were discharged alive with a follow-up plan. Of these, 32 (8.7%) died in the community within 3 months of discharge: median 22 (IQR 9-35) days from discharge to death. Most deaths were reportedly associated with acute onset of new respiratory or gastrointestinal symptoms. Those that died following discharge were significantly younger (median 6 [IQR 3,12] months) and more severely malnourished, on admission and on discharge, than those that survived. Bivariate analysis found that severe wasting on admission (OR 3.64, 95% CI 1.66-7.97) and age <12 months (OR 2.54, 95% CI 1.1-8.8) were significantly associated with post-discharge death. Of those that died in the community, none had attended a scheduled follow-up and care-seeking from a traditional healer was more common (p<0.001) compared to those who survived. CONCLUSION AND SIGNIFICANCE: Post-discharge mortality was common in Bangladeshi children following inpatient care for severe malnutrition and pneumonia. The underlying contributing factors require a better understanding to inform the potential of interventions that could improve survival.http://europepmc.org/articles/PMC4167196?pdf=render |
| spellingShingle | Mohammod Jobayer Chisti Stephen M Graham Trevor Duke Tahmeed Ahmed Abu Syed Golam Faruque Hasan Ashraf Pradip Kumar Bardhan Abu S M S B Shahid K M Shahunja Mohammed Abdus Salam Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. PLoS ONE |
| title | Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. |
| title_full | Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. |
| title_fullStr | Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. |
| title_full_unstemmed | Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. |
| title_short | Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh. |
| title_sort | post discharge mortality in children with severe malnutrition and pneumonia in bangladesh |
| url | http://europepmc.org/articles/PMC4167196?pdf=render |
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