Predictors of postdischarge mortality among hospitalised children aged 5-14 years at tertiary hospitals in Tanzania: a prospective observational cohort study.
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INTRODUCTION: Postdischarge mortality is an important but under-recognised outcome in paediatric care, particularly in resource-limited settings where reported rates vary widely. OBJECTIVES: To determine the proportion of postdischarge mortality and its predictors among children aged 5-14 years admitted to paediatric wards at Muhimbili National Hospital (MNH), Jakaya Kikwete Cardiac Institute (JKCI) and Muhimbili Orthopedic Institute (MOI). METHODS AND ANALYSIS: A prospective cohort study was conducted over 10 months among children aged 5-14 years admitted to paediatric wards at MNH, JKCI and MOI. Data were collected using a structured questionnaire. Participants were followed up by telephone at 1, 2 and 3 months after discharge. IBM SPSS Statistics V.25 was used for data analysis. Cox proportional hazards regression was used to identify factors associated with postdischarge mortality at a 5% significance level, and survival was estimated using Kaplan-Meier methods. Verbal autopsy was conducted to determine probable causes of death. RESULTS: A total of 786 participants were enrolled in the study. The median age of the participants was 7 years (IQR 5-9 years). 467 (59.4%) were male. During the 3-month follow-up, 22 of 744 (2.9%) participants with known postdischarge outcomes died.Factors associated with postdischarge mortality included HIV infection (HR 9.83, 95% CI 2.3 to 41.5), chronic kidney disease (HR 18.26, 95% CI 1.3 to 39.26), duration of symptoms >2 weeks (HR 4.7, 95% CI 1.5 to 14.73), leukocytosis (HR 7.94, 95% CI 1.97 to 32.03) and discharge against medical advice (HR 55.4, 95% CI 4.46 to 393.11).More than half of the deaths occurred within the first month after discharge, and 13 (59.1%) occurred at home. The most common probable causes were pneumonia and malignancies, each accounting for 18.2% of deaths. CONCLUSION: Postdischarge mortality was relatively low but higher in patients with chronic conditions and those discharged against medical advice. Most deaths occurred within the first month. CLINICAL TRIAL NUMBER: Not applicable.