Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review

Wiens, Matthew O.; Pawluk, Shane; Kissoon, Niranjan; Kumbakumba, Elias; Ansermino, J. Mark; Singer, Joel; Ndamira, Andrew; Larson, Charles

doi:10.1371/journal.pone.0066698

Cited by 144Global Maternal and Child HealthChild Nutrition and Water AccessPneumonia and Respiratory Infections

Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review

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Wiens, Matthew O., Pawluk, Shane, Kissoon, Niranjan, Kumbakumba, Elias, Ansermino, J. Mark, Singer, Joel, Ndamira, Andrew, Larson, Charles·2013·PLoS ONE

DOI 10.1371/journal.pone.0066698PMC PMC3692523

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Abstract

OBJECTIVES: Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death. SEARCH STRATEGY: MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion. RESULTS: Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality. CONCLUSIONS: The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.

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Postdischarge deaths generally occurred within several weeks of discharge and in many cases did not occur in hospitals.
“Postdischarge deaths generally occurred within several weeks of discharge and in many cases did not occur in hospitals [2].”
From The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda (2016) · cites this paper as [2]
The Results say most deaths occurred early in follow-up, and the Discussion says the probability of death was substantially higher during the first several months—not specifically within several weeks. The Discussion also reports that, in several studies, many children died at home rather than during a hospital readmission. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Though these interventions have been studied in other contexts, little evidence exists on their effectiveness at diminishing postdischarge mortality, and more research regarding effective strategies to decrease postdischarge mortality are urgently required.
“Though these interventions have been studied in other contexts, little evidence exists on their effectiveness at diminishing postdischarge mortality, and more research regarding effective strategies to decrease postdischarge mortality are urgently required [2,19].”
From The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda (2016) · cites this paper as [2]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
A systematic review of pediatric postdischarge mortality found that in-hospital mortality was often exceeded by mortality rates after hospitalization.
“A systematic review of pediatric postdischarge mortality found that in-hospital mortality was often exceeded by mortality rates after hospitalization.”
From The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda (2016) · cites this paper as [2]

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Authors: Wiens, M. O., Pawluk, S., Kissoon, N., Kumbakumba, E., Ansermino, J. M., Singer, J., Ndamira, A., & Larson, C.
Affiliations: Mbarara University of Science and Technology (UG)
University of British Columbia (CA)
Corresponding author: Wiens, Matthew O.
ORCID: Wiens, Matthew O.
Pawluk, Shane
Kissoon, Niranjan
Kumbakumba, Elias
Ansermino, J. Mark
Singer, Joel
Ndamira, Andrew
Larson, Charles
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2013-06-25
Volume: 8
Issue: 6
Pages: e66698
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0066698
PMC: PMC3692523
OpenAlex: W2073569962
Cited by: 144
References: 23
Citations by year: 2026: 4 · 2025: 12 · 2024: 17 · 2023: 14 · 2022: 15 · 2021: 22 · 2020: 9 · 2019: 16 · 2018: 11 · 2017: 8 · 2016: 8 · 2015: 6 · 2014: 1 · 2012: 1
FWCI: 0.71
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Canadian Child Health Clinician Scientist Program
Michael Smith Health Research BC
Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords: post-discharge mortality, child mortality, resource-poor countries, mortality risk factors, malnutrition, HIV infection, pneumonia, malaria prophylaxis, follow-up care, hospital discharge
MeSH terms: Child, Developing Countries, Health Resources, Humans, Mortality, Patient Admission, Patient Discharge

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Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review

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