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Mortality during and following hospital admission among school-aged children: a cohort study

Moses M Ngari, Christina Obiero, Martha K Mwangome, Amek Nyaguara, Neema Mturi, Sheila Murunga, Mark Otiende, Per Ole Iversen, Greg Fegan, Judd L Walson, James A Berkley

Wellcome Open Research, Volume: 5, Start page: 234

Swansea University Author: Greg Fegan

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DOI (Published version): 10.12688/wellcomeopenres.16323.2

Abstract

Background: Far less is known about the reasons for hospitalization or mortality during and after hospitalization among school-aged children than among under-fives in low- and middle-income countries. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality a...

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Published in: Wellcome Open Research
ISSN: 2398-502X
Published: F1000 Research Ltd 2021
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa56323
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Abstract: Background: Far less is known about the reasons for hospitalization or mortality during and after hospitalization among school-aged children than among under-fives in low- and middle-income countries. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality and post-discharge mortality among school-age children at Kilifi County Hospital (KCH), Kenya.Methods: A retrospective cohort study of children 5−12 years old admitted at KCH, 2007 to 2016, and resident within the Kilifi Health Demographic Surveillance System (KHDSS). Children discharged alive were followed up for one year by quarterly census. Outcomes were inpatient and one-year post-discharge mortality.Results: We included 3,907 admissions among 3,196 children with a median age of 7 years 8 months (IQR 74−116 months). Severe anaemia (792, 20%), malaria (749, 19%), sickle cell disease (408, 10%), trauma (408, 10%), and severe pneumonia (340, 8.7%) were the commonest reasons for admission. Comorbidities included 623 (16%) with severe wasting, 386 (10%) with severe stunting, 90 (2.3%) with oedematous malnutrition and 194 (5.0%) with HIV infection. 132 (3.4%) children died during hospitalisation. Inpatient death was associated with signs of disease severity, age, bacteraemia, HIV infection and severe stunting. After discharge, 89/2,997 (3.0%) children died within one year during 2,853 child-years observed (31.2 deaths [95%CI, 25.3−38.4] per 1,000 child-years). 63/89 (71%) of post-discharge deaths occurred within three months and 45% of deaths occurred outside hospital. Post-discharge mortality was positively associated with weak pulse, tachypnoea, severe anaemia, HIV infection and severe wasting and negatively associated with malaria. Conclusions: Reasons for admissions are markedly different from those reported in under-fives. There was significant post-discharge mortality, suggesting hospitalisation is a marker of risk in this population. Our findings inform guideline development to include risk stratification, targeted post-discharge care and facilitate access to healthcare to improve survival in the early months post-discharge in school-aged children.
Keywords: Mortality, Inpatient, Post-discharge, Reason for admission, School-aged children, Cohort, Africa
College: Faculty of Medicine, Health and Life Sciences
Funders: This work was supported by the Wellcome Trust through core funding for the inpatient and community surveillance [098532, 092654, 084633 and 083579]. JAB, JW, MKM and MMN are supported by the Bill & Melinda Gates Foundation as part of Childhood Acute Illness and Nutrition (CHAIN) Network [OPP1131320]. JAB is currently funded by the MRC/DFID/Wellcome Trust Joint Global Health Trials scheme [MR/M007367/1]. MMN is currently supported by the WHO/TDR Clinical Research and Development Fellowships Program. MMN had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Start Page: 234

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