Post-hospital mortality in children aged 2-12 years in Tanzania: A prospective cohort study

Hau, Duncan K.; Chami, Neema; Duncan, Aynsley; Smart, Luke R.; Hokororo, Adolfine; Kayange, Neema; Peck, Robert

doi:10.1371/journal.pone.0202334

Cited by 21 publications

(34 citation statements)

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“…This study is a secondary analysis of a prospective cohort study where we consecutively screened and enrolled children hospitalized on the pediatric wards of two public hospitals in northwestern Tanzania and followed for one-year post hospitalization [11]. The original cohort study used convenience sampling for a sample size of 500 participants to enroll from the two hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…Children 2–12 years of age hospitalized in the medical ward of BMC or STH were eligible for enrollment in the original cohort study. The original cohort study did not include children under 2 years of age, since mortality in this age group was known to be high and largely due to infectious diseases [11]. Children above 12 years were excluded since they are admitted to the adult wards at BMC and STH.…”

Section: Methodsmentioning

confidence: 99%

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Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study

et al. 2019

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Background Africa has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia. Objective To determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia. Methods We conducted a prospective cohort study enrolling children 2–12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis. Results Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53–3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00–1.03) and decreased urine output (HR 4.30, 95% Cl 1.04–17.7). Conclusions Children up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study

et al. 2019

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“…This study is a secondary analysis of a prospective cohort study where we consecutively screened and enrolled children hospitalized on the pediatric wards of two public hospitals in northwestern Tanzania and followed for one-year post hospitalization [11]. Bugando Medical Center (BMC) and Sekou-Toure Regional Referral Hospital (STH) are in the city of Mwanza, the second largest city in Tanzania and the capital of the Mwanza region.…”

Section: Methodsmentioning

confidence: 99%

Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study

Chami

Hau

Masoza

et al. 2019

Preprint

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DH) 30 31 ¶ These authors contributed equally to this work. 32 33 34 35 2 1 Abstract 2 Background: Africa has the highest rates of child mortality. Little is known about outcomes 3 after hospitalization for children with very severe anemia. 4 5 Objective: To determine one year mortality and predictors of mortality in Tanzanian children 6 hospitalized with very severe anemia. 7 8 Methods:We conducted a prospective cohort study enrolling children 2-12 years hospitalized 9 from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children 10 were screened for anemia and followed until 12 months after discharge. The primary outcome 11 measured was mortality. Predictors of mortality were determined using Cox regression analysis. 1213 Results: Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not.14 Mortality was higher for children with very severe anemia compared to children without over a 15 one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio 16 (HR) 2.42, 95% Cl 1.53-3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital 17 mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of 18 mortality were age (HR 1.01, 95% Cl 1.00-1.03) and decreased urine output (HR 4.30, 95% Cl 19 1.04 -17.7). 20 21 Conclusions: Children up to 12 years of age with very severe anemia have nearly a 30% chance 22 of mortality following admission over a one year period, with over 50% of mortality occurring 3 23 after discharge. Post-hospital interventions are urgently needed to reduce mortality in children 24 with very severe anemia, and should include older children. Very severe anemia (hemoglobin concentration less than 5.0 g/dL) is a major cause of morbidity 48 and mortality among children in Africa. Of hospitalized children, 12 to 29% have very severe 49 anemia, and the in-hospital mortality of these children range between 4 to 17% [1-9]. Little is 50 known about the long-term outcomes for children with very severe anemia after hospitalization 51 [10]. The few data that have been published have been limited to children under five years of age 52 [9]. Studies are lacking regarding long-term outcomes after hospitalization that include older 53 children with very severe anemia. 5455 Therefore, we conducted a prospective cohort study of Tanzanian children up to 12 years of age 56 hospitalized with very severe anemia and followed until one-year after hospital discharge. Our 57 study objectives were: 1) to determine the prevalence of very severe anemia for hospitalized 58 children, 2) to compare mortality in children with very severe anemia to children without very 59 severe anemia up to one year post-hospitalization, and 3) to identify predictors of mortality for 60 children with very severe anemia. 61 62 63 64 65 66 67 68 69 70 71 72 73 5 74 Methods 75 76 Study site 77 This study is a secondary analysis of a prospective cohort study where we consecutively 78 screened and enrolled children hospitalized on t...

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“…Data on post-discharge mortality is scant in many LMICs, though it has been increasing significantly over the last several years (7,8,(12)(13)(14)(15)(16)(17).…”

Section: Sub-section 1: Epidemiologymentioning

confidence: 99%

Challenges in pediatric post-sepsis care in resource limited settings: a narrative review

Wiens

Kissoon

Holsti³

2021

Transl Pediatr

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Background: Morbidity and mortality secondary to sepsis disproportionately affects children, especially those in low-and middle-income countries (LMICs), where over 85% of global cases and deaths occur.These regions are plagued by poorly resilient health systems, widespread socio-economic deprivation and unique vulnerabilities such as malnutrition. Reducing the overall burden of sepsis will require a multipronged strategy that addresses all three important periods along the sepsis care continuum -pre-facility, facility and post-facility. Of these aspects, post-facility issues have been largely neglected in research, practice and policy, and are thus the focus of this review.Methods: Relevant data for this review was identified through a literature search using PubMed, through a review of the citations of select systematic reviews and from the personal repositories of articles collected by the authors. Data is presented within three sections. The first two sections on the short and long-term outcomes among sepsis survivors each outline the epidemiology as well as review relevant interventional research done. Where clear gaps exist, these are stated. The third section focuses on priorities for future research. This section highlights the importance of data (and data systems) and of innovative interventional approaches, as key areas to improve research of post-sepsis outcomes in children. Conclusions:During the initial post-facility period, mortality is high with as many children dying during this period as during the acute period of hospitalization, mostly due to recurrent illness (including infections) which are associated with malnutrition and severe acute disease. Long-term outcomes, often labelled as postsepsis syndrome (PSS), are characterized by a lag in developmental milestones and suboptimal quality of life (QoL). While long-term outcomes have not been well characterized in resource limited settings, they are well described in high-income countries (HICs), and likely are important contributors to long-term morbidity in resource limited settings. The paucity of interventional research to improve post-discharge outcomes (short-or long-term) is a clear gap in addressing its burden. A focus on the development of improved data systems for collecting routine data, standardized definitions and terminology and a healthsystems approach in research need to be prioritized during any efforts to improve outcomes during the postsepsis phase.

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Post-hospital mortality in children aged 2-12 years in Tanzania: A prospective cohort study

Cited by 21 publications

References 19 publications

Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study

Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study

Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study

Challenges in pediatric post-sepsis care in resource limited settings: a narrative review

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