Young children in sub-Saharan Africa and South Asia who become sick or malnourished continue to have a high risk of death in the six months after being hospitalised, according to findings by researchers in the Childhood Acute Illness and Nutrition (CHAIN) Network.
Appearing in The Lancet Global Health, the study on 3,101 acutely ill children at nine hospitals in six countries across sub-Saharan Africa and South Asia found that 48% of the 350 deaths recorded occurred within six months after discharge from hospitals.
"The finding that many children die after being discharged from hospital is tragic. This calls for a review of the treatment guidelines and for home-based interventions to prevent these unfortunate deaths," said Dr Tahmeed Ahmed, executive director of icddr,b (formerly International Centre for Diarrhoeal Disease Research, Bangladesh) and one of CHAIN's lead researchers.
In the six months after discharge, a large proportion of children were at high risk with a 1 in 5 chance of dying. Post-discharge deaths could be predicted as easily as inpatient deaths from the dates of children's admission and discharge, nutritional status and social circumstance information.
Despite being highly predictable, post-discharge deaths are not addressed by clinicians and health facilities that rely on current national or WHO treatment and care guidelines. Importantly, the researchers also found that many children admitted to hospitals had very low risks of mortality.
The CHAIN researchers conducted detailed interviews with families and found that while caregivers attempted to seek care for their children, many faced barriers in accessing care and managing illness.
These findings indicate opportunities to improve the resilience and choices of caregivers, which in turn may improve timely access to medical services in case of becoming ill after discharge from a hospital.
"When acutely ill children present to care, there is not enough digging to understand how we should support these children when they go back home. These children end up in a vicious cycle of vulnerability and sometimes die," said Dr Ezekiel Mupere, chair of the Department of Paediatrics and Child Health at Makerere University, and the lead CHAIN researcher in Uganda.
"There is a lot of focus on the clinical condition of acutely ill children without putting the same magnitude as to where they are coming from and the factors which contribute to their vulnerability," Dr Ezekiel Mupere added.
The authors suggest a fundamental shift in guidelines to risk-based approaches to inpatient and post-discharge management to further reduce childhood mortality. Assessment of risk at discharge from the hospital will be an important step in preventing child deaths.
Furthermore, the authors suggest that identifying children at very low risk of death may enable the reallocation of staff and resources to higher-risk children in under-resourced health systems.