Post-discharge mortality among children under 5 years admitted with suspected sepsis in Uganda: a prospective multi-site study

BackgroundSubstantial mortality occurs after hospital discharge in children under 5 years old with suspected sepsis. A better understanding of its epidemiology is needed for effective interventions aimed at reducing child mortality in resource limited settings. MethodsIn this prospective observational cohort study, we recruited 0-60-month-old children admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. The primary outcome was six-month post-discharge mortality among those discharged alive. We evaluated the interactive impact of age, time of death, and location of death on risk factors for mortality. Findings6,545 children were enrolled, with 6,191 discharged alive. The median (interquartile range) time from discharge to death was 32 (10-92) days, with a six-month post-discharge mortality rate of 5{middle dot}5%, constituting 51% of total mortality. Deaths occurred at home (45%), intransit to care (18%), or in hospital (37%) during a subsequent readmission. Post-discharge death was strongly associated with weight-for-age z-scores < -3 (adjusted hazard ratio [aHR] 5{middle dot}04; 95%CI: 3{middle dot}97-6{middle dot}37), referral for further care (aHR 9{middle dot}08; 95%CI 6{middle dot}68-12{middle dot}34), and unplanned discharge (aHR 3{middle dot}36; 95%CI 2{middle dot}64-4{middle dot}28). The hazard ratio of those with severe anaemia increased with time since discharge, while the hazard ratios of discharge vulnerabilities (unplanned, poor feeding) decreased with time. Children with severe anaemia (<7 g/dL) died 35 days (95%CI 19{middle dot}4-51{middle dot}9) later than those without anaemia. Age influenced the effect of several variables, including anthropometric indices (less impact with increasing age), anaemia (greater impact), and admission temperature (greater impact). InterpretationPaediatric post-discharge mortality following suspected sepsis is common, with diminishing, though persistent, risk over the 6 months after discharge. Efforts to improve post-discharge outcomes are critical to achieving Sustainable Development Goal 3.2 (ending preventable childhood deaths under 5 years of age). FundingGrand Challenges Canada (#TTS-1809-1939), Thrasher Research Fund (#13878), BC Childrens Hospital Foundation, and Mining4Life.