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Post-discharge mortality among children under 5 years admitted with suspected sepsis in Uganda: a prospective multi-site study

Article scientifique 2023 Anglais

Résumé

Abstract Background Substantial mortality occurs after hospital discharge in children under 5 years old with suspected sepsis. A better understanding of its epidemiology is needed for effective interventions aimed at reducing child mortality in resource limited settings. Methods In this prospective observational cohort study, we recruited 0-60-month-old children admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. The primary outcome was six-month post-discharge mortality among those discharged alive. We evaluated the interactive impact of age, time of death, and location of death on risk factors for mortality. Findings 6,545 children were enrolled, with 6,191 discharged alive. The median (interquartile range) time from discharge to death was 32 (10–92) days, with a six-month post-discharge mortality rate of 5·5%, constituting 51% of total mortality. Deaths occurred at home (45%), intransit to care (18%), or in hospital (37%) during a subsequent readmission. Post-discharge death was strongly associated with weight-for-age z-scores < -3 (adjusted hazard ratio [aHR] 5·04; 95%CI: 3·97–6·37), referral for further care (aHR 9·08; 95%CI 6·68–12·34), and unplanned discharge (aHR 3·36; 95%CI 2·64–4·28). The hazard ratio of those with severe anaemia increased with time since discharge, while the hazard ratios of discharge vulnerabilities (unplanned, poor feeding) decreased with time. Children with severe anaemia (<7 g/dL) died 35 days (95%CI 19·4–51·9) later than those without anaemia. Age influenced the effect of several variables, including anthropometric indices (less impact with increasing age), anaemia (greater impact), and admission temperature (greater impact). Interpretation Paediatric post-discharge mortality following suspected sepsis is common, with diminishing, though persistent, risk over the 6 months after discharge. Efforts to improve post-discharge outcomes are critical to achieving Sustainable Development Goal 3.2 (ending preventable childhood deaths under 5 years of age). Funding Grand Challenges Canada (#TTS-1809-1939), Thrasher Research Fund (#13878), BC Children’s Hospital Foundation, and Mining4Life.

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Wiens, M., Bone, J., Kumbakumba, E., Businge, S., Tagoola, A., Sherine, S., Byaruhanga, E., Ssemwanga, E., Barigye, C., Nsungwa, J., Olaro, C., Ansermino, J., Kissoon, N., Singer, J., Larson, C., Lavoie, P., Dunsmuir, D., Moschovis, P., Novakowski, S., Komugisha, C., Tayebwa, M., Mwesigwa, D., Zhang, C., Knappett, M., West, N., Nguyen, V., Kenya‐Mugisha, N., Kabakyenga, J. (2023). Post-discharge mortality among children under 5 years admitted with suspected sepsis in Uganda: a prospective multi-site study. https://doi.org/10.1101/2023.01.12.23284164

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Auteur(s)

Matthew O. Wiens Jeffrey N. Bone Elias Kumbakumba Stephen Businge Abner Tagoola Sheila Oyella Sherine Emmanuel Byaruhanga Edward Ssemwanga Celestine Barigye Jesca Nsungwa Charles Olaro J. Mark Ansermino Niranjan Kissoon Joel Singer Charles P. Larson Pascal M. Lavoie Dustin Dunsmuir Peter P. Moschovis Stefanie K. Novakowski Clare Komugisha Mellon Tayebwa Douglas Mwesigwa Cherri Zhang Martina Knappett Nicholas West Vuong Nguyen Nathan Kenya‐Mugisha Jerome Kabakyenga

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