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 a...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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2011
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| _version_ | 1797069646600339456 |
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| author | Moïsi, J Gatakaa, H Berkley, J Maitland, K Mturi, N Newton, C Njuguna, P Nokes, J Ojal, J Bauni, E Tsofa, B Peshu, N Marsh, K Williams, T Scott, J |
| author_facet | Moïsi, J Gatakaa, H Berkley, J Maitland, K Mturi, N Newton, C Njuguna, P Nokes, J Ojal, J Bauni, E Tsofa, B Peshu, N Marsh, K Williams, T Scott, J |
| author_sort | Moïsi, J |
| collection | OXFORD |
| 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 | 2024-03-06T22:27:32Z |
| format | Journal article |
| id | oxford-uuid:572a4213-5913-4742-9a98-f80aa698d708 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:27:32Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:572a4213-5913-4742-9a98-f80aa698d7082022-03-26T16:55:00ZExcess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:572a4213-5913-4742-9a98-f80aa698d708EnglishSymplectic Elements at Oxford2011Moïsi, JGatakaa, HBerkley, JMaitland, KMturi, NNewton, CNjuguna, PNokes, JOjal, JBauni, ETsofa, BPeshu, NMarsh, KWilliams, TScott, JOBJECTIVE: 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. |
| spellingShingle | Moïsi, J Gatakaa, H Berkley, J Maitland, K Mturi, N Newton, C Njuguna, P Nokes, J Ojal, J Bauni, E Tsofa, B Peshu, N Marsh, K Williams, T Scott, J Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis. |
| 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 |
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