Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

King, Carina; Zadutsa, Beatiwel; Banda, Lumbani; Phiri, Everlisto; McCollum, Eric D.; Langton, Josephine; Desmond, Nicola; Qazi, Shamim; Nisar, Yasir Bin; Makwenda, Charles; Hildenwall, Helena

doi:10.2471/blt.21.287265

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…12,14 To ensure that all in need are referred early, current IMCI guidelines may need more objective definitions for timely stabilisation. 15,16 The majority of children admitted to the included hospitals had come straight to the hospital. This may suggest a good awareness among guardians on when a child's illness requires hospital care.…”

Section: Discussionmentioning

confidence: 99%

Association between care-seeking at health centres preceding hospital admission and in-hospital child mortality in rural Malawi

Selstø,

King,

Hildenwall

et al. 2023

F1000Res

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Background: Mortality among children with acute illness in low-income countries remains high. Referral issues and limitations in emergency care are major challenges to child health and a hypothesis is that care at lower-level facilities delays quality emergency care. This study investigates the extent of care-seeking at health centres prior to hospital admission for sick children, and its association with inpatient mortality in Malawi. Methods: We conducted a retrospective cohort study of children aged 0-12 years admitted to hospitals in Mchinji district, Malawi. Data was collected from September 2019 to April 2020 from one district hospital and three community hospitals. Information was collected from caregivers of admitted children, patient files and ward admission registers. The primary analysis assesses the association between referral from a health centre and in-hospital outcomes using logistic regression. Result: A total of 4926 children were included. The majority (n=4265, 86.6%) had gone straight to hospital without being referred from another health facility. The most common diagnoses were malaria (n= 3345, 67.9%), meningitis or sepsis (n= 1047, 21.3%) and pneumonia (n= 656, 13.3%). Children that were referred from a health centre had a case fatality rate of 5.3%, while those that came straight to the hospital had a case fatality rate of 2.5%. Children who had been referred from a health centre had higher odds of dying (AOR: 2.0, CI 95%: 1.3-3.0), compared to self-referred children. Children with anaemia (AOR: 4.1, CI 95%: 2.7-6.3) and malnutrition (AOR: 6.3, CI 95%: 2.7-14.6) had significantly higher odds of dying, than those without these conditions. Conclusion: Most children admitted to hospital had been taken there without a referral, and these children had better survival than those who had been referred. A better understanding of care-seeking pathways, including referral challenges, may direct interventions to improve timely provision of care for sick children.

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Section: Discussionmentioning

confidence: 99%

Association between care-seeking at health centres preceding hospital admission and in-hospital child mortality in rural Malawi

Selstø,

King,

Hildenwall

et al. 2023

F1000Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…To better compare the risk of death across different levels of hypoxaemia and for different child populations (ie, children aged <12 years), we conducted a secondary analysis of diverse study datasets, which include two inpatient study populations (Nigeria 12 and Uganda [unpublished]) and four primary care or outpatient care study populations (Nigeria, 16 Malawi, 17 Malawi, 18 and Bangladesh 19 ), all in low-altitude settings ( table ). All studies provided data on SpO 2 from the time of patient presentation, as well as clinical outcome data assessed at discharge or 14–21 days follow-up (see appendix pp 2–6 for individual study details).…”

Section: How Should Different Levels Of Hypoxaemia Be Interpreted?mentioning

confidence: 99%

Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care

Graham,

King,

Duke

et al. 2024

The Lancet Global Health

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Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Cited by 2 publications

References 29 publications

Association between care-seeking at health centres preceding hospital admission and in-hospital child mortality in rural Malawi

Association between care-seeking at health centres preceding hospital admission and in-hospital child mortality in rural Malawi

Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care

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