Abstract:
Background: Although pneumonia is a leading cause of inpatient mortality, deaths may
also occur after discharge from hospital. However, prior studies have been small, in
selected groups or did not fully evaluate risk factors, particularly malnutrition and HIV.
We determined 1-year post-discharge mortality and risk factors among children
diagnosed with severe pneumonia.
Methods: A cohort study of children aged 1-59 months admitted to Kilifi County
Hospital with severe pneumonia (2007-12). The primary outcome was death <1 year
after discharge, determined through Kilifi Health and Demographic Surveillance System
(KHDSS) quarterly census rounds.
Results: Of 4184 children (median age 9 months) admitted with severe pneumonia, 1041
(25%) had severe acute malnutrition (SAM), 267 (6.4%) had a positive HIV antibody
test, and 364 (8.7%) died in hospital. After discharge, 2279 KHDSS-resident children
were followed up; 70 (3.1%) died during 2163 child-years: 32 (95% confidence interval
(CI) 26, 41) deaths per 1000 child years. Post-discharge mortality was greater after
admission for severe pneumonia than for other diagnoses, hazard ratio 2.5 (95% CI 1.2,
5.3). Malnutrition, HIV status, age and prolonged hospitalisation, but not signs of
pneumonia severity, were associated with post-discharge mortality. Fifty-two per cent
(95% CI 37%, 63%) of post-discharge deaths were attributable to low mid-upper arm
circumference and 11% (95% CI 3.3%, 18%) to a positive HIV test.
Conclusions: Admission with severe pneumonia is an important marker of vulnerability.
Risk stratification and better understanding of the mechanisms underlying post-discharge
mortality, especially for undernourished children, are needed to reduce mortality after
treatment for pneumonia.