title: Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis.
abstract: OBJECTIVE
  To explore excess paediatric mortality after discharge from Kilifi District Hospital, Kenya, and its duration and risk factors.
  
  
  METHODS
  Hospital and demographic data were used to describe post-discharge mortality and survival probability in children aged < 15 years, by age group and clinical syndrome. Cox regression models were developed to identify risk factors.
  
  
  RESULTS
  In 2004-2008, approximately 111,000 children were followed for 555,000 person-years. We analysed 14,971 discharges and 535 deaths occurring within 365 days of discharge. Mortality was higher in the post-discharge cohort than in the community cohort (age-adjusted rate ratio, RR: 7.7; 95% confidence interval, CI: 6.6-8.9) and declined little over time. An increased post-discharge mortality hazard was found in children aged < 5 years with the following: weight-for-age Z score < -4 (hazard ratio, HR: 6.5); weight-for-age Z score > -4 but < -3 (HR: 3.4); hypoxia (HR: 2.3); bacteraemia (HR: 1.8); hepatomegaly (HR: 2.3); jaundice (HR: 1.8); hospital stay > 13 days (HR: 1.8). Older age was protective (reference < 1 month): 6-23 months, HR: 0.8; 2-4 years, HR: 0.6. Children with at least one risk factor accounted for 545 (33%) of the 1655 annual discharges and for 39 (47%) of the 83 discharge-associated deaths.
  
  
  CONCLUSIONS
  Hospital admission selects vulnerable children with a sustained increased risk of dying. The risk factors identified provide an empiric basis for effective outpatient follow-up.
authors.affiliation: KEMRI/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 Kenya. jmoisi@kilifi.kemri-wellcome.org
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Moïsi
authors.forename: Hellen
authors.initials: H
authors.lastname: Gatakaa
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: Neema
authors.initials: N
authors.lastname: Mturi
authors.forename: Charles R
authors.initials: CR
authors.lastname: Newton
authors.forename: Patricia
authors.initials: P
authors.lastname: Njuguna
authors.forename: James
authors.initials: J
authors.lastname: Nokes
authors.forename: John
authors.initials: J
authors.lastname: Ojal
authors.forename: Evasius
authors.initials: E
authors.lastname: Bauni
authors.forename: Benjamin
authors.initials: B
authors.lastname: Tsofa
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Williams
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007630:Kenya; D008297:Male; D010045:Outpatients; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data / Q000639:trends; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
references.citation: Lancet. 2004 Nov 20-26;364(9448):1865-71
references.pmid: 15555666
references.citation: Trop Med Int Health. 2000 May;5(5):377-83
references.pmid: 10886803
references.citation: Br Med J (Clin Res Ed). 1983 Oct 15;287(6399):1097-9
references.pmid: 6414583
references.citation: Am J Trop Med Hyg. 1996 Dec;55(6):655-60
references.pmid: 9025694
references.citation: Arch Dis Child. 1999 Dec;81(6):473-7
references.pmid: 10569960
references.citation: Bull World Health Organ. 1999;77(2):144-8
references.pmid: 10083713
references.citation: Bull World Health Organ. 1997;75 Suppl 1:7-24
references.pmid: 9529714
references.citation: Public Health. 2008 Sep;122(9):933-41
references.pmid: 18555498
references.citation: BMC Public Health. 2010 Mar 17;10:142
references.pmid: 20236537
references.citation: Health Policy Plan. 2005 Dec;20 Suppl 1:i5-i17
references.pmid: 16306070
references.citation: PLoS One. 2008 Aug 06;3(8):e2903
references.pmid: 18682797
references.citation: Lancet. 2008 Feb 2;371(9610):417-40
references.pmid: 18206226
references.citation: Bull World Health Organ. 2011 Feb 1;89(2):102-11
references.pmid: 21346921
references.citation: PLoS Med. 2008 Jul 22;5(7):e153
references.pmid: 18651787
references.citation: J Trop Pediatr. 1996 Dec;42(6):342-7
references.pmid: 9009560
references.citation: Acta Paediatr. 2007 Dec;96(12):1832-8
references.pmid: 18001338
references.citation: BMJ. 2005 Apr 30;330(7498):995
references.pmid: 15797893
references.citation: Pediatrics. 2010 May;125(5):e1039-47
references.pmid: 20385636
references.citation: Lancet. 2010 Jun 5;375(9730):1988-2008
references.pmid: 20546887
references.citation: Lancet. 2008 Nov 1;372(9649):1555-62
references.pmid: 18984188
references.citation: Malar J. 2007 Nov 15;6:151
references.pmid: 18005422