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Post-hospital mortality in children aged 2-12 years in Tanzania: A prospective cohort study
Duncan K Hau1, Neema Chami2,3, Aynsley Duncan4,5
1Department of Pediatrics, Weill Cornell Medical College, New York, New York, United States of America.
Insights
Post-hospital mortality is high in Tanzanian children aged 2-12 years. Interventions are crucial, particularly for older children with chronic conditions like sickle cell disease and malnutrition.
Area of Science:
- Pediatric critical care
- Global child health outcomes
- Epidemiology of child mortality
Background:
- Sub-Saharan Africa faces the world's highest child mortality rates.
- Limited data exists on post-hospital outcomes for older children after hospitalization.
- This study aimed to determine 12-month post-hospital mortality and associated factors.
Purpose of the Study:
- To assess the 12-month mortality rate in children after hospital discharge.
- To identify risk factors associated with increased mortality in this cohort.
- To inform the development of targeted post-hospital interventions.
Main Methods:
- A prospective cohort study was conducted with 506 children aged 2-12 years in Tanzania.
- Participants were followed up at 3, 6, and 12 months post-discharge.
- Cox regression analysis identified factors associated with mortality.
Main Results:
- The post-hospital mortality rate was 10.1% among 467 discharged children.
- Diagnoses like sickle cell disease, severe malnutrition, heart disease, cancer, and septic shock were linked to higher mortality.
- Risk factors included older age, lower hemoglobin, lower Glasgow Coma Scale score, decreased urine output, higher respiratory rate, impaired kidney function, and lower oxygen saturation.
Conclusions:
- Post-hospital mortality is alarmingly high for children aged 2-12 in Tanzania.
- Urgent need for post-hospital interventions, especially for older children with chronic illnesses.
- Findings highlight critical areas for improving child survival beyond acute care settings.
Background:
Sub-Saharan Africa has the highest rates of child mortality worldwide. Little is known about post-hospital outcomes after an index hospitalization for older children. We determined 12-month post-hospital mortality rate and identified factors associated with higher mortality.
Methods:
In this prospective cohort study, we enrolled children 2-12 years of age admitted to the pediatric wards of two public hospitals in northwestern Tanzania. Participants or proxies were contacted at 3, 6 and 12 months post-hospitalization. The primary outcome measured was mortality. Factors associated with mortality were determined using Cox regression analysis.
Results:
A total of 506 participants were enrolled. In-hospital mortality rate was 7.7% (39/506). Of the 467 participants discharged, the post-hospital mortality rate was 10.1% (47/467). Sickle cell disease (Hazard Ratio (HR) 3.32, 95% CI 1.44-7.68), severe malnutrition (HR 3.19, 95% CI 1.18-8.57), neurologic diseases (HR 3.51, 95% CI 1.35-9.11), heart disease (HR 7.11, 95% CI, 2.89-17.51), cancer (HR 11.79, 95% CI 4.95-28.03), and septic shock (HR 4.64, 95% CI 1.42-15.08) had higher association with mortality compared to other diagnoses. The risk factors significantly associated with mortality included older age (HR 1.01, 95% CI 1.00-1.08), lower hemoglobin level (HR 0.83, 95% CI 0.76-0.90), lower Glasgow Coma Scale (HR 0.66, 95% CI 0.59-0.74), history of decreased urine output (HR 2.87, 95% CI 1.49-5.53), higher respiratory rate (HR 1.02, 95% CI 1.00-1.03), estimated glomerular filtration rate less than 60 ml/min/1.73m2 (binary) (HR 1.84, 95% CI 1.10-3.10), and lower oxygen saturation (HR 0.96, 95% CI 0.92-0.99).
Conclusions:
Post-hospital mortality is disturbingly high among children 2-12 years of age in Tanzania. Post-hospital interventions are urgently needed especially for older children with chronic illnesses.
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