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Paediatric survival and re-admission risks following hospitalization on the Kenyan coast
R W Snow1, S C Howard, V Mung'Ala-Odera
1Kenya Medical Research Institute/Wellcome Trust Collaborative Programme, Nairobi, Kenya.
Insights
District general hospitals (DGHs) in Kenya serve many children, but readmissions and post-discharge mortality highlight the need for better care coordination. Identifying at-risk children is crucial for improving pediatric health outcomes.
Area of Science:
- Global Health
- Pediatrics
- Public Health
Background:
- District general hospitals (DGHs) are vital for healthcare in developing nations.
- Understanding DGH service utilization and impact is essential for public health.
Purpose of the Study:
- To assess the use and public health significance of DGH services in a rural Kenyan community.
- To identify children at risk of poor outcomes following DGH admission.
Main Methods:
- Linked demographic and clinical surveillance of over 4000 children near a Kenyan DGH.
- Follow-up for approximately 6 years, analyzing hospital admissions and readmissions.
Main Results:
- Approximately one-third of children were admitted to the DGH at least once.
- Higher rates of readmission for infectious diseases (malaria, ARI) and increased post-discharge mortality observed.
- Children admitted for gastroenteritis had the highest mortality post-discharge.
Conclusions:
- DGHs significantly contribute to child survival in rural Kenya.
- Readmissions and post-discharge mortality indicate a need for improved care coordination and identification of high-risk children.
- Integrated DGH and primary care services are necessary to address the needs of vulnerable children.
Abstract:
The district general hospital (DGH) is a common feature of health service provision in many developing countries. We have used linked demographic and clinical surveillance in a rural community located close to a DGH on the Kenyan coast to define the use and public health significance of essential clinical services provided by it. Of a birth cohort of over 4000 children followed for approximately 6 years, about a third were admitted to hospital at least once. Significantly more children admitted with major infectious diseases such as malaria and acute respiratory tract infections were readmitted with the same condition during the surveillance period than would have been expected by chance. Among surviving admissions, mortality post-discharge was significantly higher than in the cohort which had not been admitted within 3, 6 and 12 months. Most of the patients who died after discharge had been admitted with a diagnosis of gastroenteritis. Most children admitted to the DGH survive hospitalization and the remaining period of childhood. Despite no clinical trial evidence to support the claim, it seems reasonable to assume that in the absence of intensive clinical management provided by a DGH, a significant proportion of these children would not have survived. However, the DGH is able to define a group of at-risk children who re-present with severe complications of infectious disease, and of these several may have underlying conditions not amenable to DGH intervention and continue to have a poor prognosis. Both groups of children represent statistically significant subsets of a rural paediatric community and the future organization and co-ordination of DGH and primary care services need to work in unison to strengthen the service needs of children at risk.