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. 2023 Jan 11;13(1):e067482.
doi: 10.1136/bmjopen-2022-067482.

Trends in inpatient and post-discharge mortality among young infants admitted to Kilifi County Hospital, Kenya: a retrospective cohort study

Alison Talbert  1 , Moses Ngari  2 , Christina Obiero  2   3 , Amek Nyaguara  2 , Martha Mwangome  2 , Neema Mturi  2 , Nelson Ouma  2 , Mark Otiende  2 , James Berkley  2   4
Affiliations

Trends in inpatient and post-discharge mortality among young infants admitted to Kilifi County Hospital, Kenya: a retrospective cohort study

Alison Talbert et al. BMJ Open. .

Abstract

Objectives: To describe admission trends and estimate inpatient and post-discharge mortality and its associated exposures, among young infants (YI) admitted to a county hospital in Kenya.

Design: Retrospective cohort study.

Setting: Secondary level hospital.

Participants: YI aged less than 60 days admitted to hospital from January 2009 to December 2019: 12 271 admissions in 11 877 individuals. YI who were resident within a Kilifi Health and Demographic Surveillance System (KHDSS): n=3625 with 4421 admissions were followed-up for 1 year after discharge.

Primary and secondary outcome measures: Inpatient and 1-year post-discharge mortality, the latter in KHDSS residents.

Results: Of 12 271 YI admissions, 4421 (36%) were KHDSS-resident. Neonatal sepsis, preterm complications and birth asphyxia accounted for 83% of the admissions. The proportion of YI among under-5s admissions increased from 19% in 2009 to 34% in 2019 (Ptrend=0.02). Inpatient case fatality was 16%, with 66% of the deaths occurring within 48 hours of admission. The introduction of free maternity care in 2013 was not associated with a change in admissions or inpatient mortality among YI. During 1-year post-discharge, 208/3625 (5.7%) YI died, 64.3 (95% CI 56.2 to 73.7) per 1000 infant-years. 49% of the post-discharge deaths occurred within 1 month of discharge, and 49% of post-discharge deaths occurred at home. Both inpatient and post-discharge deaths were associated with low admission weight. Inpatient mortality was associated with clinical signs of disease severity, while post-discharge mortality was associated with the length of hospitalisation, leaving against advice and referral to a specialised hospital.

Conclusions: YIs accounted for an increasing proportion of paediatric admissions and their overall mortality remains high. Post-discharge mortality accounts for a lower proportion of deaths but mortality rate is higher than among children aged 2-59 months. Services to address post-discharge mortality are needed and should focus on infants at higher risk.

Keywords: epidemiology; neonatology; paediatrics.

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Conflict of interest statement

Competing interests: JB declares the following: Chair of the DSMB for ‘Efficacy and safety of whole-body chlorhexidine cleansing in reducing bacterial skin colonisation of hospitalised neonates - a pilot trial’. St George’s, University of London and global sites; Treasurer of the Commonwealth Society for Paediatric Gastroenterology & Nutrition.

Figures

Figure 1
Figure 1
Flow of study participants. KHDSS, Kilifi Health and Demographic Surveillance System.
Figure 2
Figure 2
Annual proportion of young infants admissions to all admissions <60 months, inpatient case fatality ratio (CFR) and post-discharge CFR. Proportions are plotted with 95% CIs.
Figure 3
Figure 3
(A) Monthly hospital admissions (with predicted mean temporal trend), (B) monthly case fatality rates (with predicted mean temporal trend), (C) monthly young infant inpatient case fatality before and after June 2013 and (D) monthly proportions of young infants to admissions <60 months old. CFR, case fatality ratio; IRR, incidence rate ratio.
See this image and copyright information in PMC

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