Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study

Titus K Kwambai; Simon Kariuki; Menno R Smit; Sarah Nevitt; Eric Onyango; Martina Oneko; Sammy Khagayi; Aaron M Samuels; Mary J Hamel; Kayla Laserson; Meghna Desai; Feiko O Ter Kuile

doi:10.4269/ajtmh.23-0186

Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study

Titus K Kwambai, Simon Kariuki, Menno R Smit, Sarah Nevitt, Eric Onyango, Martina Oneko, Sammy Khagayi, Aaron M Samuels, Mary J Hamel, Kayla Laserson, Meghna Desai, Feiko O Ter Kuile

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Abstract

Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.

Original language	English
Pages (from-to)	704-712
Number of pages	9
Journal	The American journal of tropical medicine and hygiene
Volume	109
Issue number	3
Early online date	7 Aug 2023
DOIs	https://doi.org/10.4269/ajtmh.23-0186
Publication status	Published - 6 Sept 2023

Keywords

Humans
Child
Infant
Child, Preschool
Patient Discharge
Retrospective Studies
Kenya/epidemiology
Aftercare
Malaria/complications
Anemia/complications

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Cite this

Kwambai, T. K., Kariuki, S., Smit, M. R., Nevitt, S., Onyango, E., Oneko, M., Khagayi, S., Samuels, A. M., Hamel, M. J., Laserson, K., Desai, M., & Ter Kuile, F. O. (2023). Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study. The American journal of tropical medicine and hygiene, 109(3), 704-712. https://doi.org/10.4269/ajtmh.23-0186

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abstract = "Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), {"}other conditions{"} (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.",

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Kwambai, TK, Kariuki, S, Smit, MR, Nevitt, S, Onyango, E, Oneko, M, Khagayi, S, Samuels, AM, Hamel, MJ, Laserson, K, Desai, M & Ter Kuile, FO 2023, 'Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study', The American journal of tropical medicine and hygiene, vol. 109, no. 3, pp. 704-712. https://doi.org/10.4269/ajtmh.23-0186

TY - JOUR

T1 - Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya

T2 - A Retrospective Cohort Study

AU - Kwambai, Titus K

AU - Kariuki, Simon

AU - Smit, Menno R

AU - Nevitt, Sarah

AU - Onyango, Eric

AU - Oneko, Martina

AU - Khagayi, Sammy

AU - Samuels, Aaron M

AU - Hamel, Mary J

AU - Laserson, Kayla

AU - Desai, Meghna

AU - Ter Kuile, Feiko O

PY - 2023/9/6

Y1 - 2023/9/6

N2 - Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.

AB - Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.

KW - Humans

KW - Child

KW - Infant

KW - Child, Preschool

KW - Patient Discharge

KW - Retrospective Studies

KW - Kenya/epidemiology

KW - Aftercare

KW - Malaria/complications

KW - Anemia/complications

U2 - 10.4269/ajtmh.23-0186

DO - 10.4269/ajtmh.23-0186

M3 - Article

C2 - 37549893

SN - 0002-9637

VL - 109

SP - 704

EP - 712

JO - The American journal of tropical medicine and hygiene

JF - The American journal of tropical medicine and hygiene

IS - 3

ER -