Post-hospital mortality in children aged 2-12 years in Tanzania: A prospective cohort study.
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ABSTRACT: Background
Sub-Saharan Africa has the highest rates of child mortality worldwide. Little is known about post-hospital outcomes after an index hospitalization for older children. We determined 12-month post-hospital mortality rate and identified factors associated with higher mortality.Methods
In this prospective cohort study, we enrolled children 2-12 years of age admitted to the pediatric wards of two public hospitals in northwestern Tanzania. Participants or proxies were contacted at 3, 6 and 12 months post-hospitalization. The primary outcome measured was mortality. Factors associated with mortality were determined using Cox regression analysis.Results
A total of 506 participants were enrolled. In-hospital mortality rate was 7.7% (39/506). Of the 467 participants discharged, the post-hospital mortality rate was 10.1% (47/467). Sickle cell disease (Hazard Ratio (HR) 3.32, 95% CI 1.44-7.68), severe malnutrition (HR 3.19, 95% CI 1.18-8.57), neurologic diseases (HR 3.51, 95% CI 1.35-9.11), heart disease (HR 7.11, 95% CI, 2.89-17.51), cancer (HR 11.79, 95% CI 4.95-28.03), and septic shock (HR 4.64, 95% CI 1.42-15.08) had higher association with mortality compared to other diagnoses. The risk factors significantly associated with mortality included older age (HR 1.01, 95% CI 1.00-1.08), lower hemoglobin level (HR 0.83, 95% CI 0.76-0.90), lower Glasgow Coma Scale (HR 0.66, 95% CI 0.59-0.74), history of decreased urine output (HR 2.87, 95% CI 1.49-5.53), higher respiratory rate (HR 1.02, 95% CI 1.00-1.03), estimated glomerular filtration rate less than 60 ml/min/1.73m2 (binary) (HR 1.84, 95% CI 1.10-3.10), and lower oxygen saturation (HR 0.96, 95% CI 0.92-0.99).Conclusions
Post-hospital mortality is disturbingly high among children 2-12 years of age in Tanzania. Post-hospital interventions are urgently needed especially for older children with chronic illnesses.
SUBMITTER: Hau DK
PROVIDER: S-EPMC6091952 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVE:To determine one-year, post-hospital mortality and the predictors of mortality in Tanzanian adults with heart failure (HF) compared to other admitted adults. METHODS:In this prospective cohort study we consecutively enrolled medical inpatients admitted during a 3-month period, screened for HF and followed until 12 months after hospital discharge. Standardized history, physical examination, echocardiography and laboratory investigations were obtained during hospital presentation. The primary outcome was one-year post-discharge mortality. The secondary outcome was in-hospital mortality. Cox regression adjusted for age and sex was used. RESULTS:During the study period, we enrolled 558 adults; 145 had HF and 107 of these survived until discharge. Patients with HF had a higher one-year post-hospital discharge mortality than all other diagnoses (62/107 (57.9%) vs 150/343 (43.7%), respectively, HR=1.57[1.13-2.18]). In-hospital mortality was similar. Markers of renal disease were more common in adults with HF (40/107 (37.4%) and were the strongest independent predictors of post-hospital mortality: low eGFR (HR=2.94[1.62-5.31]) and proteinuria (HR=2.03, [95%CI 1.13-3.66]). No patients discharged with the combination of low eGFR/proteinuria survived to the one-year endpoint. Of note, 79/145 (54.5%) of adults admitted with HF were newly diagnosed during hospital admission. CONCLUSIONS:Over half of adults discharged with HF died within 12months after discharge. Adults with HF had higher post-hospital mortality compared to other medical inpatients. Markers of renal disease were the strongest predictor of this mortality. Innovative interventions are needed to reduce post-hospital mortality in adults with HF and should focus on those with renal disease.
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Project description: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.
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Project description:BackgroundContinuous surveillance for intussusception (IS) is important for monitoring the safety of second-generation rotavirus vaccines. The present study aimed to assess the incidence of IS in Singaporean children aged < 2 years.MethodsThis was a prospective, hospital-based, multi-center surveillance conducted in seven hospitals - two public hospitals and five private medical centers between May 2002 and June 2010 in Singapore. Diagnosis of IS (definite, probable, possible, suspected) was based on the case definition developed by the Brighton Collaboration. Children < 2 years of age who were diagnosed with IS were enrolled in this study. Incidence of IS was calculated per 100,000 child-year with its 95% confidence interval.ResultsOf the 178 children enrolled, 167 children with definite IS cases were considered for final analyses; 11 were excluded (six diagnosed as probable IS and four diagnosed as suspected IS; one child's parents withdrew consent). Mean age of children with definite IS was 11.6 ± 6 months; 67.7% were males. The overall incidence of IS was 28.9 (95% CI: 23.0-34.8) and 26.1 (95% CI: 22.2-30.0) per 100,000 child-year in children < 1 year and < 2 years of age, respectively. The majority of IS cases (20 [12.0%]) were reported in children aged 6 months. Most children (98.2% [164/167]) recovered, two (1.2%) children recovered with sequelae and one (0.6%) child died of septic shock.ConclusionsThe incidence of IS remained low and stable in Singaporean children aged < 2 years during the study period (May 2002 to June 2010).Trial registrationNCT01177839.
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Project description:BackgroundMortality in children under five years has been widely studied, whereas mortality at 5-9 years has received little attention. Using unique data from national registers in three Nordic countries, we aimed to characterize mortality directionality in children aged 0 to 9 years.Methods and findingsThe cohort study included all children born in Denmark from 1973 to 2008 (n = 2,433,758), Sweden from 1973 to 2006 (n = 3,400,212), and a random sample of 89.3% of children born in Finland from 1987 to 2007 (n = 1,272,083). Children were followed from 0 to 9 years, and cumulative mortality and mortality rates were compared by age, gender, cause of death, and calendar periods. Among the 7,105,962 children, there were 48,299 deaths during study period. From 1981-1985 to 2001-2005, all-cause mortality rates were reduced by between 34% and 62% at different ages. Overall mortality rate ratio between boys and girls decreased from 1.25 to 1.21 with the most prominent reduction in children aged 5-9 years (from 1.59 to 1.19). Neoplasms, diseases of the nervous system and transport accidents were the most frequent cause of death after the first year of life. These three leading causes of death declined by 42% (from 6.2 to 3.6 per 100,000 person years), 43% (from 3.7 to 2.1) and 62% (from 3.9 to 1.5) in boys, and 25% (from 4.1 to 3.1 per 100000 person years), 42% (from 3.4 to 1.9) and 63% (from 3.0 to 1.1) in girls, respectively. Mortality from neoplasms was the highest in each age except infants when comparing cause-specific mortality, and half of deaths from diseases of the nervous system occurred in infancy. Mortality rate due to transport accidents increased with age and was highest in boys aged 5-9 years.ConclusionsMortality rate in children aged 0-9 years has been decreasing with diminished difference between genders over the past decades. Our results suggest the importance of further research on mortality by causes of neoplasms, and causes of transport accidents-especially in children aged 5-9 years.
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Project description:BackgroundSubstantial mortality occurs after hospital discharge in children younger than 5 years with suspected sepsis, especially in low-income countries. A better understanding of its epidemiology is needed for effective interventions to reduce child mortality in these countries. We evaluated risk factors for death after discharge in children admitted to hospital for suspected sepsis in Uganda, and assessed how these differed by age, time of death, and location of death.MethodsIn this prospective, multisite, observational cohort study, we recruited and consecutively enrolled children aged 0-60 months admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. Suspected sepsis was defined as the need for admission due to a suspected or proven infectious illness. At admission, trained study nurses systematically collected data on clinical variables, sociodemographic variables, and baseline characteristics with encrypted study tablets. Participants were followed up for 6 months after discharge by field officers who contacted caregivers at 2 months and 4 months after discharge by telephone and at 6 months after discharge in person to measure vital status, health-care seeking after discharge, and readmission details. We assessed 6-month mortality after hospital discharge among those discharged alive, with verbal autopsies conducted for children who had died after hospital discharge.FindingsBetween July 13, 2017, and March 30, 2020, 16 991 children were screened for eligibility. 6545 children (2927 [44·72%] female children and 3618 [55·28%] male children) were enrolled and 6191 were discharged from hospital alive. 6073 children (2687 [44·2%] female children and 3386 [55·8%] male children) completed follow-up. 366 children died in the 6-month period after discharge (weighted mortality rate 5·5%). Median time from discharge to death was 28 days (IQR 9-74). For the 360 children for whom location of death was documented, deaths occurred at home (162 [45·0%]), in transit to care (66 [18·3%]), or in hospital (132 [36·7%]) during a subsequent readmission. Death after hospital discharge was strongly associated with weight-for-age Z scores less than -3 (adjusted risk ratio [aRR] 4·7, 95% CI 3·7-5·8 vs a Z score of >-2), discharge or referral to a higher level of care (7·3, 5·6-9·5), and unplanned discharge (3·2, 2·5-4·0). Hazard ratios (HRs) for severe anaemia (<7g/dL) increased with time since discharge, from 1·7 (95% CI 0·9-3·0) for death occurring in the first time tertile to 5·2 (3·1-8·5) in the third time tertile. HRs for some discharge vulnerabilities decreased significantly with increasing time since discharge, including unplanned discharge (from 4.5 [2·9-6·9] in the first tertile to 2·0 [1·3-3·2] in the third tertile) and poor feeding status (from 7·7 [5·4-11·0] to 1·84 [1·0-3·3]). Age interacted with several variables, including reduced weight-for-age Z score, severe anaemia, and reduced admission temperature.InterpretationPaediatric mortality following hospital discharge after suspected sepsis is common, with diminishing, although persistent, risk during the first 6 months after discharge. Efforts to improve outcomes after hospital discharge are crucial to achieving Sustainable Development Goal 3.2 (ending preventable childhood deaths under age 5 years).FundingGrand Challenges Canada, Thrasher Research Fund, BC Children's Hospital Foundation, and Mining4Life.
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Project description:BACKGROUND:Development and evaluation of an accelerometers technique for collecting data for asses balance had reported difficulty due to equilibrium reactions and continuous bursts. The aim of this study is to determine the reliability and internal consistency of accelerometric measurements, related to static equilibrium and gait in children aged 6 to 12?years. METHODS:This descriptive and cross-sectional study involved 70 healthy children (50% girls) with a mean age of 9?years old. At the height of the 4th lumbar vertebra and directly on the skin, an accelerometer was placed on each participant. All of them had to complete four trials three times: balancing on one leg with eyes closed and eyes open, dynamic balancing on one leg on a foam mat, and normal gait. RESULTS:Results show that tests performed in older children had higher internal consistency than those performed in younger children (vertical axis r?=?0.82, sagittal axis r?=?0.77, and perpendicular axis r?=?0.74). Tests performed in children aged 8?years or older presented a strong correlation between trials (r?>?0.71). The three static equilibrium tests obtained reliability values between 0.76 y 0.84. On the contrary, gait test obtained inferior and poorer results (0.6?<?r?<?0.71). CONCLUSIONS:This method of assessment obtained positive results as an instrument for the quantitative assessment of balance in school-aged children. Values obtained for the three one-leg balance and static tests,were more strongly correlated than the normal gait test for all axes.
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Project description:BackgroundNeurological impairments might significantly contribute to reduced life expectancy in low-income and middle-income countries (LMICs). There are no empirical studies of premature mortality in children with neurological impairments in Africa. This study estimated the risk of premature mortality in children with neurological impairments and identified risk factors and causes of death.MethodsWe did a cohort study based on a two-stage epidemiological survey in the Kilifi Health and Demographic Surveillance System (Kilifi, Kenya). Study participants were children aged 6-9 years. In the first stage, five trained field workers administered a low-cost screening tool to a random sample of households. In the second stage, we assessed for neurological impairments in five domains (epilepsy, cognitive impairments, vision impairments, hearing impairments, and motor impairments) using comprehensive clinical evaluation and extensive neuropsychological assessments. From the two-stage survey we identified a cohort of children with neurological impairment and a cohort of matched controls. We also enrolled an age-matched sample from the general population. The primary outcome was all-cause mortality. Mortality rates, standardised mortality ratio (SMR), and hazard ratios (HR) for risk factors were estimated and causes of death identified.FindingsWe enrolled 306 children with neurological impairment, 9912 survey controls, and 22 873 age-matched participants from the general population, and followed up the cohorts between June 1, 2001, and Aug 31, 2018. Median follow-up was 14·5 years (IQR 8·6-17·2). 11 (3·9%) of 284 children with neurological impairment, 92 (1·0%) of 9009 controls, and 272 (1·2%) of 22 873 participants in the general population sample died during the follow-up. Overall mortality rates were 309·8 per 100 000 person-years of observation (95% CI 126·7-492·9) in children with neurological impairment, 80·8 per 100 000 person-years of observation (64·3-97·3) in controls, and 98·8 per 100 000 person-years of observation (87·1-110·6) in the general population sample (mortality rate ratio 3·83, 95% CI 2·05-7·16, p<0·001, compared with controls; 3·13, 1·71-5·72, p<0·001, compared with the general population). Mortality risk in children with neurological impairment was not dependent on the severity of impairment (p=0·291) nor on a specific neurological impairment domain (p=0·205). The overall risk of death adjusted for age and sex was higher in children with neurological impairment compared with controls (HR 4·24, 95% CI 2·26-7·94, p=0·002). An SMR of 3·15 (95% CI 1·66-5·49) was obtained after using the general population sample as the reference for indirect standardisation. In multivariable risk factor analysis, developmental delay (adjusted HR 18·92, 95% CI 2·23-160·44, p=0·007) and severe malnutrition (20·92, 3·14-139·11, p=0·002) increased the risk of mortality in children with neurological impairment. Infections such as HIV/AIDS and accidents were common among all decedents.InterpretationThe risk of premature mortality was higher in children diagnosed with neurological impairments compared with the general population and was increased by developmental delay and severe malnutrition. Child development and nutritional status should be assessed in all children in LMICs and tailored interventions started to improve outcomes.FundingWellcome Trust, DELTAS Africa Initiative.
| S-EPMC7024990 | biostudies-literature
Project description:PurposeBreastfeeding has been associated with improved cognition. It remains unclear whether long-chain polyunsaturated fatty acids (LC-PUFAs) play a role in this association. We assessed the association between LC-PUFA concentrations in infant feeding and school performance at age 12.MethodsWithin a population-based birth cohort, we compared school performance of 277 non-breastfed children and 157 children who had fatty acid composition of their mothers' breast milk measured. Two indicators of school performance were: (1) the score on a standardized achievement test and (2) the teacher's advice regarding a child's potential performance level in secondary education. Linear regression and multinomial logistic regression analyses were performed to assess the independent association between LC-PUFA content of breast milk and school performance.ResultsGirls, who received breast milk with a relative high content (above the median) of docosahexaenoic acid (DHA), had a higher Cito-test score (? = 2.96 points, 95 % CI 0.24; 5.69) than non-breastfed girls. Among the breastfed girls, each percentage point of higher content of total n-3 LC-PUFA (? = 4.55, 95 % CI 0.43; 8.66) and DHA (? = 7.09, 95 % CI 0.9; 13.3) was associated with a higher Cito-test score. The association between LC-PUFA content and teacher school advice showed a similar pattern. There was no association between LC-PUFA content and school performance in boys.ConclusionAlthough a large part of the association between infant milk feeding and cognition seems to be explained by sociodemographic and lifestyle-related factors, a relative high content of n-3 PUFAs, especially DHA, in breast milk is associated with better school performance in 12-year-old girls but not in boys.
| S-EPMC5035317 | biostudies-literature
Project description:Overweight children and childhood obesity are a public health problem in Mexico. Obesity is traditionally assessed using body mass index (BMI), but an excess of adiposity does not necessarily reflect a high BMI. Thus, body composition indexes are a better alternative. Our objective was to generate body composition percentile curves in children from Mexico City. A total of 2026 boys and 1488 girls aged 6 to 12 years old were studied in Mexico City. Body weight, height, and BMI calculation were measured. Total body fat percentage (TBFP) was derived from the skinfold thicknesses, and fat mass (FMI) and free fat mass indexes (FFMI) were calculated. Finally, age- and gender-specif?c smoothed percentile curves were generated with Cole's Lambda, Mu, and Sigma (LMS) method. In general, height, weight, waist circumference (WC), and TBFP were higher in boys, but FFM was higher in girls. TBFP appeared to increase significantly between ages 8 and 9 in boys (+2.9%) and between ages 10 and 11 in girls (+1.2%). In contrast, FFM% decreased noticeably between ages 8 and 9 until 12 years old in boys and girls. FMI values peaked in boys at age 12 (P97 = 14.1 kg/m²) and in girls at age 11 (P97 = 8.8 kg/m²). FFMI percentiles increase at a steady state reaching a peak at age 12 in boys and girls. Smoothed body composition percentiles showed a different pattern in boys and girls. The use of TBFP, FMI, and FFMI along with BMI provides valuable information in epidemiological, nutritional, and clinical research.
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Project description:OBJECTIVES:Snack foods-typically high in salt, sugar, fat and/or energy-are likely important to the obesity epidemic. In the context of a population-based health assessment involving parent-child dyads at child age 11-12 years, we report cross-generational concordance in intake at a controlled snack food observation. DESIGN:Cross-sectional study (Child Health CheckPoint), nested within the Longitudinal Study of Australian Children. SETTING:Assessment centres in seven Australian cities, February 2015-March 2016. PARTICIPANTS:Of all participating CheckPoint families (n=1874), 1299 children (50.3% girls) and 1274 parents (85.9% mothers) with snack data were included. Survey weights and methods were applied to account for the clustered multistage sample design. OUTCOME MEASURES:Partway through the 3.5-hour assessment, parents and children attended Food Stop separately for a timed 15 min 'snack break'. One of four standardised box size/content combinations was randomly provided to all participants on any given day. Total food mass, energy, nutrients and sodium consumed was measured to the nearest 1 g. Pearson's correlation coefficients and adjusted multivariable linear regression models assessed parent-child concordance in each variable. RESULTS:Children consumed less grams (151 g [SD 80] vs 165 g [SD 79]) but more energy (1393 kJ [SD 537] vs 1290 kJ [SD 658]) than parents. Parent-child concordance coefficients were small, ranging from 0.07 for sodium intake to 0.17 for carbohydrate intake. Compared with children with parents' energy intake on the 10th centile, children whose parents were on the 90th centile ate on average 227 kJ more. If extrapolated to one similar unsupervised snack on a daily basis, this equates to an additional 83 050 kJ per year, which could have a cumulative impact on additional body fat. CONCLUSIONS:Although modest at an individual level, this measured parent-child concordance in unsupervised daily snack situations could account for substantial annual population differences in energy, fat and sodium intake for children aged 11-12 years. TRIAL REGISTRATION NUMBER:ISRCTN12538380.
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