| Summary: | <h4>Background</h4> <p>Pneumonia is the leading cause of childhood mortality. Deaths may occur after discharge from hospital, but prior studies have been small, in selected groups or not fully evaluated potential risk factors, including malnutrition and HIV. We aimed to determine one year post-discharge mortality and its risk factors amongst children consecutively admitted to a rural Kenyan hospital with severe pneumonia. </p> <h4>Methods</h4> <p>A cohort study of children aged 1-59 months admitted to Kilifi County Hospital with severe pneumonia (2007-2012). The primary outcome was death within one year after discharge, determined through Kilifi Health and Demographic Surveillance System (KHDSS) quarterly census rounds. </p> <h4>Results</h4> <p>Of 4,184 children (median age 9 months) admitted with severe pneumonia, 1,041(25%) had severe acute malnutrition (SAM), 267(6.4%) had a positive HIV antibody test, and 364(8.7%) died in hospital. After discharge, 2,279 KHDSS-resident children were followed up; 70(3.1%) died during 2,163 child-years of observation (cyo): 32 [95%CI 26, 41] deaths per 1000 cyo. Post-discharge mortality was greater after admission for severe pneumonia than for other diagnoses, hazard ratio 2.50 [95%CI 1.17, 5.32]. Malnutrition, HIV status, age and prolonged hospitalization, but not signs of pneumonia severity, were associated with post-discharge mortality. 52% [95%CI 37%, 63%] of post-discharge deaths were attributable to low mid-upper arm circumference and 11% [95%CI 3.3%, 18%] to a positive HIV test. </p> <h4>Conclusions</h4> <p>Admission with severe pneumonia is an important marker of vulnerability. Risk stratification and better understanding of the mechanisms underlying post-discharge mortality, especially for undernourished children, are needed to reduce mortality after treatment for pneumonia.</p>
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