title: A cohort study of morbidity, mortality and health seeking behavior following rural health center visits by children under 12 in southwestern Uganda.
abstract: BACKGROUND
  Children discharged from hospitals in developing countries are at high risk of morbidity and mortality. However, few data describe these outcomes among children seen and discharged from rural outpatient centers.
  
  
  OBJECTIVE
  The objective of this exploratory study was to identify predictors of immediate and follow-up morbidity and mortality among children visiting a rural health center in Uganda.
  
  
  METHODS
  Subjects 0-12 years of age seeking care with a caregiver were consecutively enrolled from a single rural health center in Southwestern Uganda. Baseline variables were collected by research nurses and outcomes of referral, admission or death were recorded (immediate events). Death, hospital admission and health seeking occurring during the 30 days following the clinic visit were also determined (follow-up events). Univariate logistic regression was performed to identify baseline variables associated with immediate outcome and follow-up outcomes.
  
  
  RESULTS
  Over the four-month recruitment period 717 subjects were enrolled. There were 85 (11.9%) immediate events (10.1% were admitted, 2.2% were referred, none died). Forty-seven (7.8%) events occurred within 30 days after the visit (7.3% sought care from a health provider, 1.5% were admitted and 0.5% died). Variables associated with immediate events included living more than 30 minutes from the health center, age older than 5 years, having received an antimalarial prior to the visit, having seen a community health worker prior to the visit, elevated respiratory rate or temperature, and depressed weight-for-age z score or decreased oxygen saturation. These variables were not associated with follow-up events.
  
  
  CONCLUSIONS
  Sick-child visits at a rural health center in South Western Uganda were associated with rates of mortality and subsequent admission of less than 2% in the period following the sick child visits. Other types of health seeking behavior occurred in approximately 7% of subjects during this same period. Several variables were associated with immediate events but there were no reliable predictors of follow-up events, possibly due to low statistical power.
authors: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Matthew O
authors: MO
authors: Wiens
authors: Guy's & St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom.
authors: Heng
authors: H
authors: Gan
authors: Ministry of Health, Government of Uganda, Kampala, Uganda.
authors: Celestine
authors: C
authors: Barigye
authors: Department of Statistics, University of British Columbia, Vancouver, Canada.
authors: Guohai
authors: G
authors: Zhou
authors: Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Elias
authors: E
authors: Kumbakumba
authors: Maternal, Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Jerome
authors: J
authors: Kabakyenga
authors: Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors: Niranjan
authors: N
authors: Kissoon
authors: Department of Pediatric Anesthesia, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors: J Mark
authors: JM
authors: Ansermino
authors: Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
authors: Walter
authors: W
authors: Karlen
authors: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada; Centre for International Child Health, Child and Family Research Institute, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors: Charles P
authors: CP
authors: Larson
authors: Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada.
authors: Stuart M
authors: SM
authors: MacLeod
mesh_terms: D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D006748:Hospital Departments; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009017:Morbidity; D010045:Outpatients; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014454:Uganda
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