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. 2018 Aug 14;13(8):e0202334.
doi: 10.1371/journal.pone.0202334. eCollection 2018.

Post-hospital mortality in children aged 2-12 years in Tanzania: A prospective cohort study

Duncan K Hau  1 , Neema Chami  2   3 , Aynsley Duncan  4   5 , Luke R Smart  2   3   4   6 , Adolfine Hokororo  2   3 , Neema M Kayange  2   3 , Robert N Peck  2   3   4
Affiliations

Post-hospital mortality in children aged 2-12 years in Tanzania: A prospective cohort study

Duncan K Hau et al. PLoS One. .

Abstract

Background: Sub-Saharan Africa has the highest rates of child mortality worldwide. Little is known about post-hospital outcomes after an index hospitalization for older children. We determined 12-month post-hospital mortality rate and identified factors associated with higher mortality.

Methods: In this prospective cohort study, we enrolled children 2-12 years of age admitted to the pediatric wards of two public hospitals in northwestern Tanzania. Participants or proxies were contacted at 3, 6 and 12 months post-hospitalization. The primary outcome measured was mortality. Factors associated with mortality were determined using Cox regression analysis.

Results: A total of 506 participants were enrolled. In-hospital mortality rate was 7.7% (39/506). Of the 467 participants discharged, the post-hospital mortality rate was 10.1% (47/467). Sickle cell disease (Hazard Ratio (HR) 3.32, 95% CI 1.44-7.68), severe malnutrition (HR 3.19, 95% CI 1.18-8.57), neurologic diseases (HR 3.51, 95% CI 1.35-9.11), heart disease (HR 7.11, 95% CI, 2.89-17.51), cancer (HR 11.79, 95% CI 4.95-28.03), and septic shock (HR 4.64, 95% CI 1.42-15.08) had higher association with mortality compared to other diagnoses. The risk factors significantly associated with mortality included older age (HR 1.01, 95% CI 1.00-1.08), lower hemoglobin level (HR 0.83, 95% CI 0.76-0.90), lower Glasgow Coma Scale (HR 0.66, 95% CI 0.59-0.74), history of decreased urine output (HR 2.87, 95% CI 1.49-5.53), higher respiratory rate (HR 1.02, 95% CI 1.00-1.03), estimated glomerular filtration rate less than 60 ml/min/1.73m2 (binary) (HR 1.84, 95% CI 1.10-3.10), and lower oxygen saturation (HR 0.96, 95% CI 0.92-0.99).

Conclusions: Post-hospital mortality is disturbingly high among children 2-12 years of age in Tanzania. Post-hospital interventions are urgently needed especially for older children with chronic illnesses.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival curve for all participants.
Fig 2
Fig 2. Survival curves by diagnostic categories among acute and chronic diseases.
(A) Acute diseases; (B) Chronic diseases and acute diseases combined from Fig 2A.
See this image and copyright information in PMC

References

    1. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet. 2015; 386: 2275–2286. 10.1016/S0140-6736(15)00120-8 - DOI - PubMed
    1. Liu L, Black RE. Child survival in 2015: much accomplished, but more to do. The Lancet. 2015; 386: 2234–2235. 10.1016/S0140-6736(15)00193-2 - DOI - PubMed
    1. Anyangwe SCE, Mtonga C. Inequities in the Global Health Workforce: The Greatest Impediment to Health in Sub-Saharan Africa. Int J Environ Res Public Health. 2007; 4: 93–100 - PMC - PubMed
    1. Wiens MO, Pawluk S, Kissoon N, Kumbakumba E, Ansermino JM, Singer J, et al. Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review. PLoS ONE. 2013; 8: e66698 10.1371/journal.pone.0066698 - DOI - PMC - PubMed
    1. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. The Lancet. 2013; 381: 1405–1416. 10.1016/S0140-6736(13)60222-6 - DOI - PMC - PubMed

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