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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
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2022-07-08T10:23:13.4337579</datestamp><bib-version>v2</bib-version><id>56323</id><entry>2021-02-25</entry><title>Mortality during and following hospital admission among school-aged children: a cohort study</title><swanseaauthors><author><sid>a9005418b89918776f3d8895ba42e850</sid><firstname>Greg</firstname><surname>Fegan</surname><name>Greg Fegan</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2021-02-25</date><deptcode>FGMHL</deptcode><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&#x2212;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&#x2212;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&#x2212;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.</abstract><type>Journal Article</type><journal>Wellcome Open Research</journal><volume>5</volume><journalNumber/><paginationStart>234</paginationStart><paginationEnd/><publisher>F1000 Research Ltd</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2398-502X</issnElectronic><keywords>Mortality, Inpatient, Post-discharge, Reason for admission, School-aged children, Cohort, Africa</keywords><publishedDay>8</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-01-08</publishedDate><doi>10.12688/wellcomeopenres.16323.2</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><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 &amp; 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.</funders><lastEdited>2022-07-08T10:23:13.4337579</lastEdited><Created>2021-02-25T10:31:59.6267187</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Moses M</firstname><surname>Ngari</surname><order>1</order></author><author><firstname>Christina</firstname><surname>Obiero</surname><order>2</order></author><author><firstname>Martha K</firstname><surname>Mwangome</surname><order>3</order></author><author><firstname>Amek</firstname><surname>Nyaguara</surname><order>4</order></author><author><firstname>Neema</firstname><surname>Mturi</surname><order>5</order></author><author><firstname>Sheila</firstname><surname>Murunga</surname><order>6</order></author><author><firstname>Mark</firstname><surname>Otiende</surname><order>7</order></author><author><firstname>Per Ole</firstname><surname>Iversen</surname><order>8</order></author><author><firstname>Greg</firstname><surname>Fegan</surname><order>9</order></author><author><firstname>Judd L</firstname><surname>Walson</surname><order>10</order></author><author><firstname>James A</firstname><surname>Berkley</surname><order>11</order></author></authors><documents><document><filename>56323__19455__fa7ed50fe15c432bbf43778b586a4c5d.pdf</filename><originalFilename>56323.pdf</originalFilename><uploaded>2021-03-09T13:20:03.5883614</uploaded><type>Output</type><contentLength>1096408</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2021 Ngari MM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2022-07-08T10:23:13.4337579 v2 56323 2021-02-25 Mortality during and following hospital admission among school-aged children: a cohort study a9005418b89918776f3d8895ba42e850 Greg Fegan Greg Fegan true false 2021-02-25 FGMHL 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. Journal Article Wellcome Open Research 5 234 F1000 Research Ltd 2398-502X Mortality, Inpatient, Post-discharge, Reason for admission, School-aged children, Cohort, Africa 8 1 2021 2021-01-08 10.12688/wellcomeopenres.16323.2 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 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. 2022-07-08T10:23:13.4337579 2021-02-25T10:31:59.6267187 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Moses M Ngari 1 Christina Obiero 2 Martha K Mwangome 3 Amek Nyaguara 4 Neema Mturi 5 Sheila Murunga 6 Mark Otiende 7 Per Ole Iversen 8 Greg Fegan 9 Judd L Walson 10 James A Berkley 11 56323__19455__fa7ed50fe15c432bbf43778b586a4c5d.pdf 56323.pdf 2021-03-09T13:20:03.5883614 Output 1096408 application/pdf Version of Record true © 2021 Ngari MM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title Mortality during and following hospital admission among school-aged children: a cohort study
spellingShingle Mortality during and following hospital admission among school-aged children: a cohort study
Greg Fegan
title_short Mortality during and following hospital admission among school-aged children: a cohort study
title_full Mortality during and following hospital admission among school-aged children: a cohort study
title_fullStr Mortality during and following hospital admission among school-aged children: a cohort study
title_full_unstemmed Mortality during and following hospital admission among school-aged children: a cohort study
title_sort Mortality during and following hospital admission among school-aged children: a cohort study
author_id_str_mv a9005418b89918776f3d8895ba42e850
author_id_fullname_str_mv a9005418b89918776f3d8895ba42e850_***_Greg Fegan
author Greg Fegan
author2 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
format Journal article
container_title Wellcome Open Research
container_volume 5
container_start_page 234
publishDate 2021
institution Swansea University
issn 2398-502X
doi_str_mv 10.12688/wellcomeopenres.16323.2
publisher F1000 Research Ltd
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2021-01-08T04:11:11Z
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score 11.013148

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