Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study
Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study
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DOI：
10.4314/ahs.v16i4.2
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发表时间：
2016-01-01
影响因子：
1
通讯作者：
Wiens, M. O.
中科院分区：
文献类型：
--
作者：
English, Lacey;Kumbakumba, Elias;Wiens, M. O.
背景：生活在资源匮乏环境中的儿童院外死亡经常发生。鲜为人知的是，儿童死亡的位置和情况下，出院后hospitaldischarge.Objectives：本研究旨在了解周围的背景下，院外死亡和障碍，以获得及时的护理乌干达儿童最近出院从hospital.Methods：这是一个混合方法的子研究在乌干达西南部地区进行的出院后死亡率的一个较大的队列研究。患有传染病的儿童有资格参加队列研究，然后在出院后随访6个月。在出院后6个月期间在医院外死亡的儿童的照顾者有资格参加这项子研究。定性访谈和单变量Logistic回归进行，以确定预测的院外deaths.Results：出院的1,242名儿童，61人死亡，在出院后的6个月期间，与大多数（n=40，66%）死在医院外。母亲受教育程度的递增与院外死亡的几率低于院内死亡的几率相关（OR：0.38，95%CI：0.19 - 0.81）。定性分析确定了出院后就医行为和常见障碍，延迟死亡前的就医。对于最近出院的儿童，照顾者往往表示犹豫，以寻求照顾后，最近一次发作的hospitalization.Conclusion：出院后死亡率往往发生在医院的范围之外。除了资源有限外，护理人员的健康知识和观念也会对及时获得护理产生影响。降低儿童死亡率的干预措施必须考虑到出院后儿童就医的障碍。
Background: Out-of-hospital death among children living in resource poor settings occurs frequently. Little is known about the location and circumstances of child death following a hospital discharge.Objectives: This study aimed to understand the context surrounding out-of-hospital deaths and the barriers to accessing timely care for Ugandan children recently discharged from the hospital.Methods: This was a mixed-methods sub-study within a larger cohort study of post-discharge mortality conducted in the Southwestern region of Uganda. Children admitted with an infectious illness were eligible for enrollment in the cohort study, and then followed for six months after discharge. Caregivers of children who died outside of the hospital during the six month post-discharge period were eligible to participate in this sub-study. Qualitative interviews and univariate logistic regression were conducted to determine predictors of out-of-hospital deaths.Results: Of 1,242 children discharged, 61 died during the six month post-discharge period, with most (n=40, 66%) dying outside of a hospital. Incremental increases in maternal education were associated with lower odds of out-of-hospital death compared to hospital death (OR: 0.38, 95% CI: 0.19 - 0.81). The qualitative analysis identified health seeking behaviors and common barriers within the post-discharge period which delayed care seeking prior to death. For recently discharged children, caregivers often expressed hesitancy to seek care following a recent episode of hospitalization.Conclusion: Mortality following discharge often occurs outside of a hospital context. In addition to resource limitations, the health knowledge and perceptions of caregivers can be influential to timely access to care. Interventions to decrease child mortality must consider barriers to health seeking among children following hospital discharge.