Inpatient and postdischarge mortality among children with anaemia and malaria parasitaemia in Kenya: a cohort study.

IF 7.1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

BMJ Global Health Pub Date : 2024-10-21 DOI:10.1136/bmjgh-2024-016600

Moses Ngari, Martha Mwangome, Nelson Ouma, Amek Nyaguara, Neema Mturi, Christina Obiero, Alice Kamau, Judd L Walson, Per O Iversen, Kathryn Maitland, Robert W Snow, James Berkley

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引用次数: 0

Abstract

Background: Anaemia and malaria are leading causes of paediatric hospitalisation and inpatient mortality in sub-Saharan Africa. However, there is limited empirical data on survival following hospital discharge. We aimed to estimate independent effects of anaemia and malaria parasitaemia on inpatient and 1 year postdischarge mortality among Kenyan children.

Methods: A retrospective cohort study among children admitted to Kilifi County Hospital (KCH) from 2010 to 2019 and followed-up for 1 year postdischarge in Kilifi Health and Demographic Surveillance System (KHDSS). The main exposures were anaemia and malaria parasitaemia at the time of hospital admission while inpatient and 1 year postdischarge mortality were the outcomes.

Results: We included 9431 admissions among 7578 children (43% girls), median (IQR) age 19 (9.9‒23) months. 2069 (22%), 3893 (41%) and 1140 (12%) admissions had mild, moderate and severe anaemia, whereas 366 (3.9%), 779 (8.3%) and 224 (2.4%) had low, medium and high malaria parasitaemia, respectively. Overall, there were 381 (4.0%) inpatient deaths: 317/381 (83%) and 47/381 (12%) among children with any level of anaemia and malaria parasitaemia, respectively. Moderate and severe, but not mild anaemia, were positively associated with inpatient death. Low and high level parasitaemia were positively associated with inpatient mortality, while medium level parasitaemia was negatively associated. There were 228 (3.1%) postdischarge deaths: 32.8 (95% CI 28.8‒37.3) deaths/1000 child-years. 180/228 (79%) deaths occurred within 6 months after index discharge and 99/228 (43%) occurred in the community. Overall, 180/228 (79%) and 10/228 (4.4%) postdischarge deaths occurred among children with any level of anaemia and malaria parasitaemia, respectively. Severe anaemia was positively associated with postdischarge mortality (adjusted HR 1.94 (95% CI 1.11‒3.40)), while medium level parasitaemia was negatively associated.

Conclusion: Interventions to create awareness of postdischarge risks, improve uptake of existing interventions and improved discharge processes targeting high-risk groups such as children admitted with severe anaemia, need to be prioritised.

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肯尼亚贫血和疟疾寄生虫病儿童的住院和出院后死亡率：一项队列研究。

背景：贫血和疟疾是撒哈拉以南非洲地区儿科住院和住院病人死亡的主要原因。然而，有关出院后存活率的经验数据却很有限。我们旨在估算贫血和疟疾寄生虫血症对肯尼亚儿童住院和出院一年后死亡率的独立影响：方法：对基利菲县医院（Kilifi County Hospital，KCH）从 2010 年至 2019 年收治的儿童进行回顾性队列研究，并在基利菲健康与人口监测系统（Kilifi Health and Demographic Surveillance System，KHDSS）中进行出院后 1 年的随访。主要暴露因素是入院时的贫血和疟疾寄生虫血症，结果是住院病人和出院后 1 年的死亡率：我们纳入了 7578 名儿童（43% 为女孩）中的 9431 例住院病例，中位数（IQR）年龄为 19（9.9-23）个月。分别有 2069 名（22%）、3893 名（41%）和 1140 名（12%）儿童患有轻度、中度和重度贫血，而分别有 366 名（3.9%）、779 名（8.3%）和 224 名（2.4%）儿童患有低度、中度和高度疟疾寄生虫血症。总体而言，住院病人死亡人数为 381 人（4.0%），其中 317/381 人（83%）和 47/381 人（12%）分别患有任何程度的贫血症和疟疾寄生虫病。中度和重度贫血与住院病人死亡呈正相关，但轻度贫血与住院病人死亡无关。低度和高度寄生虫血症与住院病人死亡率呈正相关，而中度寄生虫血症则呈负相关。出院后死亡人数为 228 人（3.1%）：每千名儿童年死亡人数为 32.8 人（95% CI 28.8-37.3）。180/228（79%）例死亡发生在指数出院后 6 个月内，99/228（43%）例死亡发生在社区。总体而言，180/228（79%）和 10/228（4.4%）例出院后死亡病例分别发生在患有任何程度贫血和疟疾寄生虫血症的儿童中。重度贫血与出院后死亡率呈正相关（调整后 HR 1.94 (95% CI 1.11-3.40)），而中度寄生虫血症与出院后死亡率呈负相关：需要优先考虑针对高危人群（如患有严重贫血的入院儿童）采取干预措施，以提高对出院后风险的认识，改善现有干预措施的使用率，并改进出院流程。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Global Health Medicine-Health Policy

CiteScore

11.40

自引率

4.90%

发文量

429

审稿时长

18 weeks

期刊介绍： BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.