Post-Discharge Risk of Mortality in Children Under Five Years of Age in Western Kenya: A Retrospective Cohort Study

Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months post-discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged <5 years using mortality data from a Health and Demographic Surveillance System that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall, in-hospital mortality was 2∙8% (101/3,639). The mortality by six months post-discharge (primary outcome) was 6.2% (159/2,556) and highest in children with severe acute malnutrition (SAM) (21·6%), followed by severe anemia (15·5%), severe pneumonia (5·6%), ‘other conditions’ (5·6%), and severe malaria (0·7%). Overall, the six-month post-discharge mortality in children hospitalized with SAM (HR=3·95, 2·60-6·00, p<0∙001) or severe anemia (HR=2·55, 1·74-3·71, p<0.001) was significantly higher than in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality (HR=0·33, 0·21-0·53, p<0.001). The odds of dying by six months post-discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first six months post-discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.