Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review

Wiens, Matthew O.; Pawluk, Shane; Kissoon, Niranjan; Kumbakumba, Elias; Ansermino, J. Mark; Singer, Joel; Ndamira, Andrew; Larson, Charles P.

doi:10.1371/journal.pone.0066698

Cited by 114 publications

(135 citation statements)

References 18 publications

Supporting

Mentioning

130

Contrasting

Order By: Relevance

“…Post-discharge deaths generally occurred early (within several weeks of discharge) and in many cases did not occur in hospitals. 4 A recent systematic analysis of severe acute respiratory infections (ARIs) in children under 5 years found that although most episodes (62%) were treated in the hospital, 81% of the deaths from severe respiratory infection occurred outside of the hospital. 2 This study did not identify the proportion of out of hospital deaths which at some point received hospital care.…”

Section: Introductionmentioning

confidence: 99%

“…7 Malnutrition, previous hospitalizations and HIV are often identified as key risk factors for post-discharge mortality. 4 While these risk factors may assist clinicians in the identification of vulnerable children, many other contextual and social factors may contribute to post-discharge mortality. Currently, little is known about the health seeking decisions made by caregivers following hospitalizations for acute illness.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

L¹,

Kumbakumba²,

et al. 2017

Afr H. Sci.

Self Cite

View full text Add to dashboard Cite

Background: Out-of-hospital death among children living in resource poor settings occurs frequently. Little is known about the location and circumstances of child death following a hospital discharge. Objectives: This study aimed to understand the context surrounding out-of-hospital deaths and the barriers to accessing timely care for Ugandan children recently discharged from the hospital. Methods: This was a mixed-methods sub-study within a larger cohort study of post-discharge mortality conducted in the Southwestern region of Uganda. Children admitted with an infectious illness were eligible for enrollment in the cohort study, and then followed for six months after discharge. Caregivers of children who died outside of the hospital during the six month post-discharge period were eligible to participate in this sub-study. Qualitative interviews and univariate logistic regression were conducted to determine predictors of out-of-hospital deaths. Results: Of 1,242 children discharged, 61 died during the six month post-discharge period, with most (n=40, 66%) dying outside of a hospital. Incremental increases in maternal education were associated with lower odds of out-of-hospital death compared to hospital death (OR: 0.38, 95% CI: 0.19 -0.81). The qualitative analysis identified health seeking behaviors and common barriers within the post-discharge period which delayed care seeking prior to death. For recently discharged children, caregivers often expressed hesitancy to seek care following a recent episode of hospitalization. Conclusion: Mortality following discharge often occurs outside of a hospital context. In addition to resource limitations, the health knowledge and perceptions of caregivers can be influential to timely access to care. Interventions to decrease child mortality must consider barriers to health seeking among children following hospital discharge. Keywords: Pediatrics, post-discharge mortality, Uganda, qualitative interviews, infectious diseas.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

L¹,

Kumbakumba²,

et al. 2017

Afr H. Sci.

Self Cite

View full text Add to dashboard Cite

show abstract

“…The median age of these children was 6 months, and according to the authors, were suspected to have suffered a relapse of pneumonia. The most important variables associated with post-discharge mortality were determined to be young age and malnutrition according to a multivariate analysis [30]. Severe anemia specifically has been predicted to account for higher post-hospital discharge mortality in children [15].…”

Section: Study Population Standard Of Care In Hicmentioning

confidence: 99%

Clinical Profile of Hospitalized Community Acquired Childhood Pneumonia in Dhaka, Bangladesh

Choudhury¹

2017

CSMC

View full text Add to dashboard Cite

Introduction: The 2 major bacterial causes of childhood pneumonia are Hemophilus influenzae type b (Hib) and Streptococcus pneumonia (SPN). The objective of this study was to describe clinical profile of hospitalized CAP cases in children in a Low Middle Income Country (LMIC) and compare to practices in High Income Countries (HIC). The goal was to justify maternal immunization during pregnancy. Methods:Medical records of patients admitted between March' 2014 and August' 2014 were reviewed. 219 cases were identified with lower respiratory tract diseases, among which 83 were diagnosed as bacterial CAP and enrolled into this study. Intercooled stata" version 8.0 was used for statistical analyses.Result: Mean age for male was 5.9 months and for female was 11.7 months; mean weight for male was 5.8 kilograms and for female was 6.5 kilograms. Eighty-nine percent of this population was under 12 months, 69 percent was under 6 months and 22 percent was under 2 months of age. Infants under 6 months were more likely to be tachypneic (p=0.04) and hypoxic (p=0.05) when compared to infants and children over 6 months of age. Younger infants under 2 months were even more likely to be tachypneic (p= 0.002) but less likely wheezing (p=0.001) when compared to infants over 2 months of age. Infants under 2 months were 14x at higher risk (Odds ratio [OR]) (p=0.002) for tachypnea. Infants under 6 months were 3x at higher risk (OR) for tachypnea (p=0.02) and hypoxia (p=0.03) when compared to infants and children over 6 months of age. Underweight (< 3 rd percentile for age) children were (p=0.01) 2.4 times (OR) more likely to be in respiratory distress than children with normal weight. Conclusion:Prevalence of vaccine preventable CAP is common under 12 months of age. Maternal immunization during pregnancy with SPN and Hib vaccines is deemed to be justifiable and a cost effective strategy for community acquired childhood pneumonia prevention in LMIC.

show abstract

“…A recent systematic review has found that the months following hospital discharge account for at least as many deaths as the hospital period. 4 Despite the apparently high burden of post discharge mortality in children, little currently exists to address this important issue. The identification of vulnerable children is an important first step in addressing this important public health problem.…”

Section: Introductionmentioning

confidence: 99%

Selecting candidate predictor variables for the modelling of post-discharge mortality from sepsis: a protocol development project

Wiens¹,

Kissoon²,

Kumbakumba³

et al. 2016

Afr H. Sci.

Self Cite

View full text Add to dashboard Cite

Background: Post-discharge mortality is a frequent but poorly recognized contributor to child mortality in resource limited countries. The identification of children at high risk for post-discharge mortality is a critically important first step in addressing this problem. Objectives: The objective of this project was to determine the variables most likely to be associated with post-discharge mortality which are to be included in a prediction modelling study. Methods: A two-round modified Delphi process was completed for the review of a priori selected variables and selection of new variables. Variables were evaluated on relevance according to (1) prediction (2) availability (3) cost and (4) time required for measurement. Participants included experts in a variety of relevant fields. Results: During the first round of the modified Delphi process, 23 experts evaluated 17 variables. Forty further variables were suggested and were reviewed during the second round by 12 experts. During the second round 16 additional variables were evaluated. Thirty unique variables were compiled for use in the prediction modelling study. Conclusion: A systematic approach was utilized to generate an optimal list of candidate predictor variables for the incorporation into a study on prediction of pediatric post-discharge mortality in a resource poor setting.

show abstract

Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review

Cited by 114 publications

References 18 publications

Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

Clinical Profile of Hospitalized Community Acquired Childhood Pneumonia in Dhaka, Bangladesh

Selecting candidate predictor variables for the modelling of post-discharge mortality from sepsis: a protocol development project

Contact Info

Product

Resources

About