Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis

Objective To explore excess paediatric mortality after discharge from Kilifi District Hospital, Kenya, and its duration and risk factors. Methods Hospital and demographic data were used to describe post-discharge mortality and survival probability in children aged < 15. years, by age group and clinical syndrome. Cox regression models were developed to identify risk factors. Findings In 2004-2008, approximately 111 000 children were followed for 555 000 person years. We analysed 14 971 discharges and 535 deaths occurring within 365 days of discharge. Mortality was higher in the post-discharge cohort than in the community cohort (age-adjusted rate ratio, RR: 7.7; 95% confidence interval, CI: 6.6-8.9) and declined little overtime. An increased post-discharge mortality hazard was found in children aged <5 years with the following: weight-for-age Z score <-4 (hazard ratio, HR: 6.5); weight-for-age Z score > -4 but < -3 (HR: 3.4); hypoxia (HR: 2.3); bacteraemia (HR: 1.8); hepatomegaly (HR: 2.3); jaundice (HR: 1.8); hospital stay > 13 days (HR: 1.8). Older age was protective (reference < 1 month): 6-23 months, HR: 0.8; 2-4 years, HR: 0.6. Children with at least one risk factor accounted for 545 (33%) of the 1655 annual discharges and for 39 (47%) of the 83 discharge-associated deaths. Conclusion Hospital admission selects vulnerable children with a sustained increased risk of dying. The risk factors identified provide an empiric basis for effective outpatient follow-up.