Abstract
Background: Far less is known about the reasons for hospitalization or mortality during and after hospitalization among school-aged children than among under-fives in low- and middle-income countries. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality and post-discharge mortality among school-age children at Kilifi County Hospital (KCH), Kenya. Methods: A retrospective cohort study of children 5-12 years old admitted at KCH, 2007 to 2016, and resident within the Kilifi Health Demographic Surveillance System (KHDSS). Children discharged alive were followed up for one year by quarterly census. Outcomes were inpatient and one-year post-discharge mortality. Results: We included 3,907 admissions among 3,196 children with a median age of 7 years 8 months (IQR 74-116 months). Severe anaemia (792, 20%), malaria (749, 19%), sickle cell disease (408, 10%), trauma (408, 10%), and severe pneumonia (340, 8.7%) were the commonest reasons for admission. Comorbidities included 623 (16%) with severe wasting, 386 (10%) with severe stunting, 90 (2.3%) with oedematous malnutrition and 194 (5.0%) with HIV infection. 132 (3.4%) children died during hospitalisation. Inpatient death was associated with signs of disease severity, age, bacteraemia, HIV infection and severe stunting. After discharge, 89/2,997 (3.0%) children died within one year during 2,853 child-years observed (31.2 deaths [95%CI, 25.3-38.4] per 1,000 child-years). 63/89 (71%) of post-discharge deaths occurred within three months and 45% of deaths occurred outside hospital. Post-discharge mortality was positively associated with weak pulse, tachypnoea, severe anaemia, HIV infection and severe wasting and negatively associated with malaria. Conclusions: Reasons for admissions are markedly different from those reported in under-fives. There was significant post-discharge mortality, suggesting hospitalisation is a marker of risk in this population. Our findings inform guideline development to include risk stratification, targeted post-discharge care and facilitate access to healthcare to improve survival in the early months post-discharge in school-aged children.
Highlights
Despite a remarkable decline in global child mortality, more than 6 million children died in 2018, of which 0.9 million (15%) deaths occurred among children aged 5 to 14 years, mostly in low- and middle-income countries (LMICs)[1,2]
Post-discharge mortality is increasingly recognized as a significant contributor to the burden of mortality among under-fives in. In this retrospective cohort study, we aimed to describe the reasons for hospitalisation, underlying illnesses, and the clinical characteristics and features associated with mortality during hospitalisation and for one year after discharge among children 5 to 12 years old admitted to a rural hospital in Kenya
We found no evidence that anaemia (P=0.16), age (P=0.21) or severe wasting (P=0.14) modified the effect of malaria on inpatient mortality
Summary
Despite a remarkable decline in global child mortality, more than 6 million children died in 2018, of which 0.9 million (15%) deaths occurred among children aged 5 to 14 years, mostly in low- and middle-income countries (LMICs)[1,2]. Children ≥5 years old may be admitted to hospital with different conditions than younger children and their risks for inpatient or post-discharge mortality may differ. Among school-aged children admitted to six Kenyan hospitals in 2013, 3.5% of children aged 5 to 9 years and 5.0% of children 10 to 14 years died[5] Infectious diseases such as malaria were the main reported causes of death in children ≥5 years[2,5,6]. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality and post-discharge mortality among school-age children at Kilifi County Hospital (KCH), Kenya. 89/2,997 (3.0%) children died within one year during 2,853 child-years observed (31.2 deaths [95%CI, 25.3−38.4] per 1,000 child-years). 63/89 (71%) of post-discharge version 2 (revision)
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