Child Mortality after Discharge from a Health Facility following Suspected Pneumonia, Meningitis or Septicaemia in Rural Gambia: A Cohort Study

Chhibber, Aakash Varun; Hill, Philip C.; Jafali, James; Jasseh, Momodou; Hossain, Mohammad Ilias; Ndiaye, M.; Pathirana, Jayani; Greenwood, Brian; Mackenzie, Grant

doi:10.1371/journal.pone.0137095

Cited by 29 publications

(28 citation statements)

References 19 publications

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“…Our findings concur with data from Bangladesh in suggesting that children who died after admission were younger and more severely malnourished. The proportions (7.3% and 11%) of severely malnourished children with severe pneumonia who died within 3 and 6 months after discharge were also very similar to published data from Gambia and Bangladesh . Likewise, amongst children without malnutrition, our finding of ~1% who died post‐discharge also was very similar to studies in Gambia and Bangladesh, suggesting generalisability when stratified by nutritional status, despite the potential limitations of our study outlined below.…”

Section: Commentsupporting

confidence: 87%

Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study

Ngari

Fegan

Mwangome

et al. 2017

Paediatric Perinatal Epid

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BackgroundAlthough pneumonia is a leading cause of inpatient mortality, deaths may also occur after discharge from hospital. However, prior studies have been small, in selected groups or did not fully evaluate risk factors, particularly malnutrition and HIV. We determined 1‐year post‐discharge mortality and risk factors among children diagnosed with severe pneumonia.MethodsA cohort study of children aged 1–59 months admitted to Kilifi County Hospital with severe pneumonia (2007–12). The primary outcome was death <1 year after discharge, determined through Kilifi Health and Demographic Surveillance System (KHDSS) quarterly census rounds.ResultsOf 4184 children (median age 9 months) admitted with severe pneumonia, 1041 (25%) had severe acute malnutrition (SAM), 267 (6.4%) had a positive HIV antibody test, and 364 (8.7%) died in hospital. After discharge, 2279 KHDSS‐resident children were followed up; 70 (3.1%) died during 2163 child‐years: 32 (95% confidence interval (CI) 26, 41) deaths per 1000 child years. Post‐discharge mortality was greater after admission for severe pneumonia than for other diagnoses, hazard ratio 2.5 (95% CI 1.2, 5.3). Malnutrition, HIV status, age and prolonged hospitalisation, but not signs of pneumonia severity, were associated with post‐discharge mortality. Fifty‐two per cent (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.ConclusionsAdmission 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.

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Section: Commentsupporting

confidence: 87%

Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study

Ngari

Fegan

Mwangome

et al. 2017

Paediatric Perinatal Epid

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“…Comparative mortality data for the group of non-treated children admitted for presumptive TB are very scarce. However, the mortality (4.5%) was close to what has been recently reported for admitted children including post discharge mortality from high HIV burden countries 19,20 . The low proportion of non-TB treated cases retrospectively classified as confirmed or probable TB (1%) seems to indicate that the risk of missed diagnosis of TB was low in this cohort.…”

Section: A C C E P T E Dsupporting

confidence: 84%

Outcome of Children With Presumptive Tuberculosis in Mbarara, Rural Uganda

Bonnet¹,

Nansumba

Bastard³

et al. 2018

Pediatric Infectious Disease Journal

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“…9,14,15 For specific diseases, PDM risks have ranged between 2.0% and 2.6% for malaria, 16,17 2.9% and 7% for diarrhea, 18,19 2.7% and 11.6% for anemia, 20 and 1% and 15% for pneumonia 15,21 and remained at 2.8% for invasive bacterial infections. 7 Most of these deaths have been described as clustering in the first 30 days, 13 and main predictors of PDM include a history of previous hospitalizations, young age, HIV infection, and hospitalizations related to malnutrition or pneumonia. 4 A rigorous follow-up of all children who are discharged from the hospital would be unfeasible and unaffordable in resource-constrained settings.…”

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confidence: 99%

Postdischarge Mortality Prediction in Sub-Saharan Africa

et al. 2019

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BACKGROUND: Although the burden of postdischarge mortality (PDM) in low-income settings appears to be significant, no clear recommendations have been proposed in relation to follow-up care after hospitalization. We aimed to determine the burden of pediatric PDM and develop predictive models to identify children who are at risk for dying after discharge. METHODS:Deaths after hospital discharge among children aged <15 years in the last 17 years were reviewed in an area under demographic and morbidity surveillance in Southern Mozambique. We determined PDM over time (up to 90 days) and derived predictive models of PDM using easily collected variables on admission. RESULTS:Overall PDM was high (3.6%), with half of the deaths occurring in the first 30 days. One primary predictive model for all ages included young age, moderate or severe malnutrition, a history of diarrhea, clinical pneumonia symptoms, prostration, bacteremia, having a positive HIV status, the rainy season, and transfer or absconding, with an area under the curve of 0.79 (0.75-0.82) at day 90 after discharge. Alternative models for all ages including simplified clinical predictors had a similar performance. A model specific to infants <3 months old was used to identify as predictors being a neonate, having a low weight-for-age z score, having breathing difficulties, having hypothermia or fever, having oral candidiasis, and having a history of absconding or transfer to another hospital, with an area under the curve of 0.76 (0.72-0.91) at day 90 of follow-up. CONCLUSIONS: Death after discharge is an important although poorly recognized contributor to child mortality. A simple predictive algorithm based on easily recognizable variables could readily be used to identify most infants and children who are at a high risk of dying after discharge.abstract

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Child Mortality after Discharge from a Health Facility following Suspected Pneumonia, Meningitis or Septicaemia in Rural Gambia: A Cohort Study

Cited by 29 publications

References 19 publications

Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study

Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study

Outcome of Children With Presumptive Tuberculosis in Mbarara, Rural Uganda

Postdischarge Mortality Prediction in Sub-Saharan Africa

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