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Paediatric postdischarge mortality in developing countries: a systematic review
Brooklyn Nemetchek1, Lacey English2, Niranjan Kissoon3,4
1College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Insights
Paediatric postdischarge mortality (PDM) in developing countries is a significant issue, with rates often matching in-hospital deaths. Most child deaths occur at home, highlighting the need for targeted interventions before discharge.
Area of Science:
- Global Health
- Paediatric Medicine
- Epidemiology
Background:
- Postdischarge mortality (PDM) in children from developing countries is a critical yet under-addressed global health challenge.
- Existing evidence on PDM risk factors, timing, and location requires regular updating to inform effective interventions.
Purpose of the Study:
- To provide an updated evidence base on paediatric postdischarge mortality (PDM) in developing countries.
- To evaluate key risk factors, the timing, and the location of PDM events.
Main Methods:
- A systematic literature review was conducted, synthesizing data from 24 eligible studies published up to July 2017.
- Studies were primarily from African nations and included diverse paediatric subpopulations such as those with malnutrition, respiratory infections, and diarrheal diseases.
Main Results:
- PDM rates were found to be comparable to or exceed in-hospital mortality rates.
- Children with malnutrition and respiratory infections exhibited the highest PDM rates (3%-20%), while those with anemia and malaria had lower rates (1%-2%).
- Over two-thirds of postdischarge deaths occurred at home, with significant risk factors including HIV status, young age, pneumonia, and malnutrition.
Conclusions:
- Postdischarge mortality represents a substantial burden, often occurring at home, underscoring the need for pre-discharge interventions.
- Developing evidence-based, risk-guided interventions is crucial for addressing this neglected cause of mortality and achieving Sustainable Development Goals.
Objectives:
To update the current evidence base on paediatric postdischarge mortality (PDM) in developing countries. Secondary objectives included an evaluation of risk factors, timing and location of PDM.
Design:
Systematic literature review without meta-analysis.
Data Sources:
Searches of Medline and EMBASE were conducted from October 2012 to July 2017.
Eligibility Criteria:
Studies were included if they were conducted in developing countries and examined paediatric PDM. 1238 articles were screened, yielding 11 eligible studies. These were added to 13 studies identified in a previous systematic review including studies prior to October 2012. In total, 24 studies were included for analysis.
Data Extraction And Synthesis:
Two independent reviewers extracted and synthesised data using Microsoft Excel.
Results:
Studies were conducted mostly within African countries (19 of 24) and looked at all admissions or specific subsets of admissions. The primary subpopulations included malnutrition, respiratory infections, diarrhoeal diseases, malaria and anaemia. The anaemia and malaria subpopulations had the lowest PDM rates (typically 1%-2%), while those with malnutrition and respiratory infections had the highest (typically 3%-20%). Although there was significant heterogeneity between study populations and follow-up periods, studies consistently found rates of PDM to be similar, or to exceed, in-hospital mortality. Furthermore, over two-thirds of deaths after discharge occurred at home. Highly significant risk factors for PDM across all infectious admissions included HIV status, young age, pneumonia, malnutrition, anthropometric variables, hypoxia, anaemia, leaving hospital against medical advice and previous hospitalisations.
Conclusions:
Postdischarge mortality rates are often as high as in-hospital mortality, yet remain largely unaddressed. Most children who die following discharge do so at home, suggesting that interventions applied prior to discharge are ideal to addressing this neglected cause of mortality. The development, therefore, of evidence-based, risk-guided, interventions must be a focus to achieve the sustainable development goals.
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