Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis
Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis
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DOI：
10.2471/blt.11.089235
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发表时间：
2011-10-01
影响因子：
11.1
通讯作者：
Scott, J. Anthony G.
中科院分区：
文献类型：
--
作者：
Moisi, Jennifer C.;Gatakaa, Hellen;Scott, J. Anthony G.
目的 探讨肯尼亚基利菲地区医院出院后儿童超额死亡率及其持续时间和危险因素。方法采用医院和人口数据，按年龄组和临床症状描述 15 岁以下儿童的出院后死亡率和生存概率。 Cox 回归模型的开发是为了识别风险因素。调查结果 2004 年至 2008 年，大约 111 000 名儿童接受了 555 000 人年的随访。我们分析了出院 365 天内发生的 14 971 例出院病例和 535 例死亡病例。出院后队列的死亡率高于社区队列（年龄调整死亡率比，RR：7.7；95％置信区间，CI：6.6-8.9），并且随时间推移略有下降。 13 天龄儿童出院后死亡风险增加（HR：1.8）。年龄较大有保护作用（参考<1个月）：6-23个月，HR：0.8； 2-4年，HR：0.6。每年 1655 例出院儿童中，有至少一种危险因素的儿童占 545 例 (33%)；在 83 例出院相关死亡中，有 39 例 (47%)。 结论 入院选择的是死亡风险持续增加的弱势儿童。确定的风险因素为有效的门诊随访提供了经验基础。
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 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.