Predictors of post-discharge mortality among children aged 5-14 years admitted to Paediatrics wards at JKCI,MNH and MOI: a prospective observational cohort study

Abstract

ABSTRACT Background: It is estimated that over 1 million children aged 5-14 years died in the year 2017, with 55% of the deaths occurring in Sub-Saharan Africa. Mortality of children following hospital discharge is reported to be high ranging between 1-18% and may exceed in-hospital mortality in lower-income countries. In Tanzania, there is a paucity of data on post-discharge mortality rate and its predictors among children aged 5-14 years. Objectives: To determine the post-discharge mortality rate and its predictors among children aged 5-14 years admitted to paediatrics wards at MNH, JKCI, and MOI. Methodology: A prospective observational cohort study was conducted among children aged 5-14 years admitted to paediatrics wards at MNH, JKCI, and MOI. Data was collected using a structured questionnaire, and collected information included socio-demographic characteristics, clinical profiles, and patients’ outcomes. Post-discharge follow-up was carried out using phone calls at 1, 2, and 3 months following discharge. Data was analyzed using SPSS version 25. The association of demographic, social economic, and clinical factors with the outcome of all causes, 3 months post-discharge mortality was determined by Cox regression, and survival rates were displayed through Kaplan-Meier curves. Results: A total of 786 children were enrolled in the study. The mean age of the children was 7.6 years (SD=2.8). There was a slight male preponderance of 59.4%. Of the 744 children discharged, the post-hospital mortality was 2.9%. Children with HIV disease (Hazard Ratio (HR) 9.83, 95 CI 2.3-41.5) and chronic kidney disease (Hazard Ratio (HR) 18.26, 95 CI 1.3 39.26) were found to have a high post-discharge mortality. The predictors of post-discharge mortality were noted to be the duration of symptoms >2 weeks (Hazard Ratio (HR) 4.7, 95 CI 1.5-14.73), leukocytosis (Hazard Ratio (HR) 7.49, 95 CI 1.97 32.03), and discharge against medical advice (Hazard Ratio (HR) 55.4, 95 CI 4.46-393.11). More than half of the deaths occurred within the first month post-discharge, with more than 50% of them occurring outside the hospital. Conclusion and Recommendations: The findings emphasize on the need for improved follow up care for children aged 5-14 years, particularly those with chronic conditions or discharged against medical advice. Most deaths occurred within the first month, often at home, highlighting the importance of early post-discharge interventions for high-risk patients.