Childhood mortality during and after acute illness in Africa and south Asia: a prospective cohort study

Diallo, Abdoulaye Hama; Shahid, Abu Sadat Mohammad Sayeem Bin; Khan, Azharul Islam; Saleem, Ali Faisal; Singa, Benson; Gnoumou, Blaise Siezanga; Tigoi, Caroline; Otieno, Catherine Achieng; Bourdon, Céline; Oduol, Chris Odhiambo; Lancioni, Christina; Manyasi, Christine; McGrath, Christine J.; Maronga, Christopher; Lwanga, Christopher; Brals, Daniëlla; Ahmed, Dilruba; Mondal, Dinesh; Denno, Donna M.; Mangale, Dorothy I.; Chimezi, Emmanuel; Mbale, Emmie; Mupere, Ezekiel; Mamun, Gazi Md. Salahuddin; Ouédraogo, Issaka; Berkley, James A.; Njirammadzi, Jenala; Mukisa, John; Thitiri, Johnstone; Carreon, Joseph D.; Walson, Judd L.; Jemutai, Julie; Tickell, Kirkby D; Shahrin, Lubaba; Mallewa, Macpherson; Hossain, Md. Iqbal; Chisti, Mohammod Jobayer; Timbwa, Molly; Mburu, Moses; Ngari, Moses; Ngao, Narshion; Aber, Peace; Harawa, Philliness Prisca; Sukhtankar, Priya; Bandsma, Robert; Bamouni, Roseline Maimouna; Molyneux, Sassy; Mwaringa, Shalton; Shaima, Shamsun Nahar; Ali, Syed Asad; Afsana, Syeda Momena; Banu, Syera; Ahmed, Tahmeed; Voskuijl, Wieger; Kazi, Zaubina

doi:10.1016/s2214-109x(22)00118-8

Cited by 65 publications

(107 citation statements)

References 23 publications

(30 reference statements)

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“…There is growing evidence suggesting that mortality after hospital discharge among children in low-income and middle-income countries (LMICs) is a major problem. 1 – 3 Malaria and severe anaemia are leading causes of hospital admission and death in many parts of Africa with longer-term effects beyond the inpatient period. 1 , 2 A previous systematic review of paediatric mortality after discharge in Africa in 2018 identified six papers reporting children admitted with severe anaemia, malaria, or both, but did not compare risks with other health conditions or perform a meta-analysis.…”

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confidence: 99%

“…This review is a valuable contribution to our growing understanding of mortality and morbidity following hospital discharge and highlights the background of vulnerability among children before admission and after discharge from hospital. The concept of hospital admissions occurring within a child’s overall health trajectory 3 is particularly well illustrated by the finding that showed that there is a 2·69-times higher risk of 6-month mortality after discharge associated with a previous admission for severe anaemia compared with admission for other health conditions. 4 …”

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confidence: 99%

“…It was notable that more than two-thirds of deaths occurred at home without a hospital readmission, posing a challenge in understanding the causes and reasons for not seeking medical care. 1 , 3 These issues show the complexity of post-hospital syndrome. We consider that death after discharge may be caused by a new episode of illness, separate and unrelated to the index admission event, but reflecting ongoing susceptibility; incomplete or failed treatment of the reason for the index admission; or a condition that is acquired or exacerbated in hospital, such as a new infection, antimicrobial resistance, drug toxicity, or malnutrition, which later results in death ( appendix ).…”

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confidence: 99%

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Severe anaemia and paediatric mortality after hospital discharge in Africa

Ngari¹,

Berkley²

2022

The Lancet Child & Adolescent Health

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confidence: 99%

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confidence: 99%

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Severe anaemia and paediatric mortality after hospital discharge in Africa

Ngari¹,

Berkley²

2022

The Lancet Child & Adolescent Health

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“…This high mortality risk may be due to illness severity, underlying comorbidities such as malnutrition, limited healthcare access and resources, and poverty. The results of the CHAIN cohort, as well as other studies, suggest that half of all mortality in children admitted for acute illness in these settings occurs after discharge 5,11,12 but a large group of children can be identified as low risk. In the past decade, very few novel biological interventions have demonstrated the ability to reduce mortality among children in LMIC with acute illnesses 13,14 .…”

Section: Introductionmentioning

confidence: 82%

The Childhood Acute Illness and Nutrition (CHAIN) network nested case-cohort study protocol: a multi-omics approach to understanding mortality among children in sub-Saharan Africa and South Asia

et al. 2022

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Introduction: Many acutely ill children in low- and middle-income settings have a high risk of mortality both during and after hospitalisation despite guideline-based care. Understanding the biological mechanisms underpinning mortality may suggest optimal pathways to target for interventions to further reduce mortality. The Childhood Acute Illness and Nutrition (CHAIN) Network (www.chainnnetwork.org) Nested Case-Cohort Study (CNCC) aims to investigate biological mechanisms leading to inpatient and post-discharge mortality through an integrated multi-omic approach. Methods and analysis; The CNCC comprises a subset of participants from the CHAIN cohort (1278/3101 hospitalised participants, including 350 children who died and 658 survivors, and 270/1140 well community children of similar age and household location) from nine sites in six countries across sub-Saharan Africa and South Asia. Systemic proteome, metabolome, lipidome, lipopolysaccharides, haemoglobin variants, toxins, pathogens, intestinal microbiome and biomarkers of enteropathy will be determined. Computational systems biology analysis will include machine learning and multivariate predictive modelling with stacked generalization approaches accounting for the different characteristics of each biological modality. This systems approach is anticipated to yield mechanistic insights, show interactions and behaviours of the components of biological entities, and help develop interventions to reduce mortality among acutely ill children. Ethics and dissemination. The CHAIN Network cohort and CNCC was approved by institutional review boards of all partner sites. Results will be published in open access, peer reviewed scientific journals and presented to academic and policy stakeholders. Data will be made publicly available, including uploading to recognised omics databases. Trial registration NCT03208725.

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“…We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) Cohort, a multicountry prospective study of acutely ill children admitted to hospitals [19]. CHAIN recruited participants from nine hospitals across six countries; Bangladesh (icddr,b Dhaka Hospital, and Matlab Hospital), Burkina Faso (Banfora Regional Referral Hospital), Kenya (Kilifi County Hospital, Mbagathi Sub-County Hospital, and Migori County Referral Hospital), Malawi (Queen Elizabeth Central Hospital), Pakistan (Civil Hospital Karachi), and Uganda (Mulago National Referral Hospital) between 2016 and 2019.…”

Section: Methodsmentioning

confidence: 99%

The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia

et al. 2022

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Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.

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Childhood mortality during and after acute illness in Africa and south Asia: a prospective cohort study

Cited by 65 publications

References 23 publications

Severe anaemia and paediatric mortality after hospital discharge in Africa

Severe anaemia and paediatric mortality after hospital discharge in Africa

The Childhood Acute Illness and Nutrition (CHAIN) network nested case-cohort study protocol: a multi-omics approach to understanding mortality among children in sub-Saharan Africa and South Asia

The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia

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