title: Variation in and risk factors for paediatric inpatient all-cause mortality in a low income setting: data from an emerging clinical information network.
abstract: Hospital mortality data can inform planning for health interventions and may help optimize resource allocation if they are reliable and appropriately interpreted. However such data are often not available in low income countries including Kenya.
  
  
  
  Data from the Clinical Information Network covering 12 county hospitals' paediatric admissions aged 2-59 months for the periods September 2013 to March 2015 were used to describe mortality across differing contexts and to explore whether simple clinical characteristics used to classify severity of illness in common treatment guidelines are consistently associated with inpatient mortality. Regression models accounting for hospital identity and malaria prevalence (low or high) were used. Multiple imputation for missing data was based on a missing at random assumption with sensitivity analyses based on pattern mixture missing not at random assumptions.
  
  
  
  The overall cluster adjusted crude mortality rate across hospitals was 6 · 2% with an almost 5 fold variation across sites (95% CI 4 · 9 to 7 · 8; range 2 · 1% - 11 · 0%). Hospital identity was significantly associated with mortality. Clinical features included in guidelines for common diseases to assess severity of illness were consistently associated with mortality in multivariable analyses (AROC =0 · 86).
  
  
  
  All-cause mortality is highly variable across hospitals and associated with clinical risk factors identified in disease specific guidelines. A panel of these clinical features may provide a basic common data framework as part of improved health information systems to support evaluations of quality and outcomes of care at scale and inform health system strengthening efforts.
authors.affiliation: Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya. dgathara@kemri-wellcome.org.
authors.forename: David
authors.initials: D
authors.lastname: Gathara
authors.affiliation: Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK.
authors.forename: Lucas
authors.initials: L
authors.lastname: Malla
authors.affiliation: Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya.
authors.forename: Philip
authors.initials: P
authors.lastname: Ayieko
authors.affiliation: Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya.
authors.forename: Stella
authors.initials: S
authors.lastname: Karuri
authors.affiliation: Division of Maternal, Newborn, Child and Adolescent Health, Ministry of Health, Nairobi, Kenya.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nyamai
authors.affiliation: Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya.|Department of Paediatrics and Child Health, University of Nairobi, Nairobi, 19676-00202, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Irimu
authors.affiliation: Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, 22700 1100, DE, The Netherlands.
authors.forename: Michael Boele
authors.initials: MB
authors.lastname: van Hensbroek
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.affiliation: Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D063005:Health Information Systems; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006766:Hospitals, County / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: Clinical risk factors; Hospital; Mortality; Paediatrics; Quality of care; Variability