UBC Theses and Dissertations
Childhood mortality from acute infectious diseases in Uganda : studies in sepsis and post-discharge mortality Wiens, Matthew Owen
Background and objectives: The fourth Millennium Development Goal to reduce childhood mortality by two-thirds will not be achieved in most countries of sub-Saharan Africa. Infectious diseases are the most common cause of death in these children. A significant period of vulnerability occurs in the weeks and months following discharge. We sought to characterize mortality both in-hospital and post-discharge in children admitted with infectious diseases and develop prediction models for these outcomes. Methods: The primary study was a cohort study of children 6 months to 5 years of age admitted with proven or suspected infections. Children were followed throughout hospitalization and until six months post-discharge. Prediction models for in-hospital and post-discharge mortality were developed using standard logistic regression techniques. A further prospective cohort study was conducted to determine morbidity, mortality and health seeking following pediatric outpatient department visits in a rural health facility. Results: The primary cohort study enrolled 1307 subjects who were admitted with a proven or suspected infection. Sixty five (5.0%) children died in hospital and 61 (4.9%) of children died during the six month post-discharge period. Parsimonious models were developed for both in-hospital and post-discharge mortality. Variables for in-hospital prediction included Blantyre coma score, weight for age z-score, and HIV status. Variables for post-discharge prediction included Blantyre coma score, mid-upper arm circumference, HIV status, oxygen saturation and time since last hospitalization. Both models performed well with areas under of receiver operating characteristics curve of 0.85 and 0.80, respectively. Most (65%) post-discharge deaths occurred outside of a hospital. The secondary study of out-patient department visits included 717 sick-child visits and found that mortality and subsequent admission over 30 days occurs after approximately 2% of visits. Health seeking occurred in 7% of sick-child visits. No baseline clinical factors were associated with outcomes following these visits. Interpretation: The derived models can be used to develop effective interventions to improve in-hospital care, referral of admitted subjects to higher levels of care, and post-discharge care. Further research is required to better understand health seeking following out-patient department visits.
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