Paediatric postdischarge mortality in developing countries: a systematic review

Abstract

ObjectivesTo update the current evidence base on paediatric postdischarge mortality (PDM) in developing countries. Secondary objectives included an evaluation of risk factors, timing and location of PDM.DesignSystematic literature review without meta-analysis.Data sourcesSearches of Medline and EMBASE were conducted from October 2012 to July 2017.Eligibility criteriaStudies were included if they were conducted in developing countries and examined paediatric PDM. 1238 articles were screened, yielding 11 eligible studies. These were added to 13 studies identified in a previous systematic review including studies prior to October 2012. In total, 24 studies were included for analysis.Data extraction and synthesisTwo independent reviewers extracted and synthesised data using Microsoft Excel.ResultsStudies were conducted mostly within African countries (19 of 24) and looked at all admissions or specific subsets of admissions. The primary subpopulations included malnutrition, respiratory infections, diarrhoeal diseases, malaria and anaemia. The anaemia and malaria subpopulations had the lowest PDM rates (typically 1%–2%), while those with malnutrition and respiratory infections had the highest (typically 3%–20%). Although there was significant heterogeneity between study populations and follow-up periods, studies consistently found rates of PDM to be similar, or to exceed, in-hospital mortality. Furthermore, over two-thirds of deaths after discharge occurred at home. Highly significant risk factors for PDM across all infectious admissions included HIV status, young age, pneumonia, malnutrition, anthropometric variables, hypoxia, anaemia, leaving hospital against medical advice and previous hospitalisations.ConclusionsPostdischarge mortality rates are often as high as in-hospital mortality, yet remain largely unaddressed. Most children who die following discharge do so at home, suggesting that interventions applied prior to discharge are ideal to addressing this neglected cause of mortality. The development, therefore, of evidence-based, risk-guided, interventions must be a focus to achieve the sustainable development goals.

Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study

“…However, children with cSAM experience a high rate of mortality and readmission in the months following hospital discharge especially in sub-Saharan Africa (Berkley et al, 2016;Chhibber et al, 2015;Dubray et al, 2008;Kerac et al, 2009;Moisi et al, 2011;Ngari et al, 2017;Trehan et al, 2013;Veirum, Sodeman, Biai, Hedegård, & Aaby, 2007;Wiens et al, 2013;Wiens et al, 2015). Recent systematic reviews reported paediatric post-discharge mortality rates in resource-poor countries of up to 18% that may exceed in-hospital mortality rates in many settings (Nemetchek et al, 2018;Wiens et al, 2013). Further, postdischarge relapse is poorly defined and infrequently systematically measured in programmes, and therefore less understood.…”

Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

“…1740 (30) 506 (22) 936 (42) 68 (15) 95 3739 4418 (22) 78 ( (30) 566 (25) 757 (34) 165 (37) 81 3227 3116 (20) 97 (28) Information NA 509 (9) 211 (9) 176 (8) 30 730 127 813 1642 (12) Ethnicity, n (%) Brahmin and Chhetri 2573 (45) 944 (41) 1072 (48)…”

Parent and Provider Perspectives on Factors Influencing Treatment-Seeking and Recovery After Hospital Discharge Among Undernourished Children Aged 2-23 Months in Bangladesh

“…Early discharge from hospital against medical advice is signi cantly associated in Bangladesh as in other developing countries with higher post-discharge mortality and re-admission [4,6,37]. In line with a previous study conducted at icddr,b hospitals [4], we found that mothers who were taking their children home against medical advice were doing so for a range of inter-related reasons, including a view that the child had either recovered enough to go home (ie the child's condition was improving or he/she had recovered from the primary illness), or was not going to recover and so should be taken home.…”