Trends in inpatient and post-discharge mortality among young infants admitted to Kilifi County Hospital, Kenya: a retrospective cohort study

BMJ Open. 2023 Jan 11;13(1):e067482. doi: 10.1136/bmjopen-2022-067482.

Abstract

Objectives: To describe admission trends and estimate inpatient and post-discharge mortality and its associated exposures, among young infants (YI) admitted to a county hospital in Kenya.

Design: Retrospective cohort study.

Setting: Secondary level hospital.

Participants: YI aged less than 60 days admitted to hospital from January 2009 to December 2019: 12 271 admissions in 11 877 individuals. YI who were resident within a Kilifi Health and Demographic Surveillance System (KHDSS): n=3625 with 4421 admissions were followed-up for 1 year after discharge.

Primary and secondary outcome measures: Inpatient and 1-year post-discharge mortality, the latter in KHDSS residents.

Results: Of 12 271 YI admissions, 4421 (36%) were KHDSS-resident. Neonatal sepsis, preterm complications and birth asphyxia accounted for 83% of the admissions. The proportion of YI among under-5s admissions increased from 19% in 2009 to 34% in 2019 (Ptrend=0.02). Inpatient case fatality was 16%, with 66% of the deaths occurring within 48 hours of admission. The introduction of free maternity care in 2013 was not associated with a change in admissions or inpatient mortality among YI. During 1-year post-discharge, 208/3625 (5.7%) YI died, 64.3 (95% CI 56.2 to 73.7) per 1000 infant-years. 49% of the post-discharge deaths occurred within 1 month of discharge, and 49% of post-discharge deaths occurred at home. Both inpatient and post-discharge deaths were associated with low admission weight. Inpatient mortality was associated with clinical signs of disease severity, while post-discharge mortality was associated with the length of hospitalisation, leaving against advice and referral to a specialised hospital.

Conclusions: YIs accounted for an increasing proportion of paediatric admissions and their overall mortality remains high. Post-discharge mortality accounts for a lower proportion of deaths but mortality rate is higher than among children aged 2-59 months. Services to address post-discharge mortality are needed and should focus on infants at higher risk.

Keywords: epidemiology; neonatology; paediatrics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aftercare
  • Child
  • Child, Preschool
  • Female
  • Hospital Mortality
  • Hospitalization
  • Hospitals, County
  • Humans
  • Infant
  • Infant, Newborn
  • Inpatients
  • Kenya / epidemiology
  • Maternal Health Services*
  • Patient Discharge*
  • Pregnancy
  • Retrospective Studies