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Verbal Autopsy to Assess Postdischarge Mortality in Children With Suspected Sepsis in Uganda
Martina Knappett1, Anneka Hooft2,3, Muhammad Bilal Maqsood4
1Institute for Global Health, British Columbia Children's & Women's Hospital, Vancouver, Canada.
Insights
Verbal autopsies in Uganda revealed that pneumonia, sepsis, malaria, and diarrhea were leading causes of death in young children after hospital discharge. Malnutrition and anemia were common contributing factors, highlighting needs for targeted interventions.
Area of Science:
- Pediatric mortality research
- Public health surveillance
- Epidemiology in low-income countries
Background:
- Child mortality in low-income countries is hampered by insufficient vital statistics.
- Verbal autopsies are a viable method for determining causes of death in data-scarce settings.
- This study investigated pediatric postdischarge mortality causes in children under five admitted for suspected sepsis.
Purpose of the Study:
- To assess the causes of death in children under five following hospital discharge for suspected sepsis.
- To identify key factors contributing to pediatric mortality in the post-discharge period.
- To inform potential public health interventions for reducing child mortality.
Main Methods:
- Secondary analysis of verbal autopsy data from Ugandan hospitals (July 2017-March 2020).
- Structured interviews for deaths within six months post-discharge.
- Independent physician classification of causes of death using the Start-Up Mortality List, with consensus for discrepancies.
Main Results:
- Verbal autopsies were completed for 361 of 366 (98.6%) children who died post-discharge.
- Leading causes of death included pneumonia (26.2%), sepsis (22.1%), malaria (8.5%), and diarrhea (7.9%).
- Malnutrition (50.5%) and anemia (25.7%) were significant contributing factors; deaths were more common in the community (62.3%).
Conclusions:
- Postdischarge mortality in Ugandan children admitted for sepsis often occurs in the community.
- Verbal autopsy findings indicate a need for interventions targeting early infection detection.
- Preventing and treating malnutrition and anemia are crucial for reducing pediatric mortality.
Background:
Reducing child mortality in low-income countries is constrained by a lack of vital statistics. In the absence of such data, verbal autopsies provide an acceptable method to determining attributable causes of death. The objective was to assess potential causes of pediatric postdischarge mortality in children younger than age 5 years (under-5) originally admitted for suspected sepsis using verbal autopsies.
Methods:
Secondary analysis of verbal autopsy data from children admitted to 6 hospitals across Uganda from July 2017 to March 2020. Structured verbal autopsy interviews were conducted for all deaths within 6 months after discharge. Two physicians independently classified a primary cause of death, up to 4 alternative causes, and up to 5 contributing conditions using the Start-Up Mortality List, with discordance resolved by consensus.
Results:
Verbal autopsies were completed for 361 (98.6%) of the 366 (5.9%) children who died among 6191 discharges (median admission age: 5.4 months [interquartile range, 1.8-16.7]; median time to mortality: 28 days [interquartile range, 9-74]). Most deaths (62.3%) occurred in the community. Leading primary causes of death, assigned in 356 (98.6%) of cases, were pneumonia (26.2%), sepsis (22.1%), malaria (8.5%), and diarrhea (7.9%). Common contributors to death were malnutrition (50.5%) and anemia (25.7%). Reviewers were less confident in their causes of death for neonates than older children (P < .05).
Conclusions:
Postdischarge mortality frequently occurred in the community in children admitted for suspected sepsis in Uganda. Analyses of the probable causes for these deaths using verbal autopsies suggest potential areas for interventions, focused on early detection of infections, as well as prevention and treatment of underlying contributors such as malnutrition and anemia.
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