School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
Guy's & St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom.
PLoS One. 2015 Jan 30;10(1):e0118055. doi: 10.1371/journal.pone.0118055. eCollection 2015.
BACKGROUND: Children discharged from hospitals in developing countries are at high risk of morbidity and mortality. However, few data describe these outcomes among children seen and discharged from rural outpatient centers. OBJECTIVE: The objective of this exploratory study was to identify predictors of immediate and follow-up morbidity and mortality among children visiting a rural health center in Uganda. METHODS: Subjects 0-12 years of age seeking care with a caregiver were consecutively enrolled from a single rural health center in Southwestern Uganda. Baseline variables were collected by research nurses and outcomes of referral, admission or death were recorded (immediate events). Death, hospital admission and health seeking occurring during the 30 days following the clinic visit were also determined (follow-up events). Univariate logistic regression was performed to identify baseline variables associated with immediate outcome and follow-up outcomes. RESULTS: Over the four-month recruitment period 717 subjects were enrolled. There were 85 (11.9%) immediate events (10.1% were admitted, 2.2% were referred, none died). Forty-seven (7.8%) events occurred within 30 days after the visit (7.3% sought care from a health provider, 1.5% were admitted and 0.5% died). Variables associated with immediate events included living more than 30 minutes from the health center, age older than 5 years, having received an antimalarial prior to the visit, having seen a community health worker prior to the visit, elevated respiratory rate or temperature, and depressed weight-for-age z score or decreased oxygen saturation. These variables were not associated with follow-up events. CONCLUSIONS: Sick-child visits at a rural health center in South Western Uganda were associated with rates of mortality and subsequent admission of less than 2% in the period following the sick child visits. Other types of health seeking behavior occurred in approximately 7% of subjects during this same period. Several variables were associated with immediate events but there were no reliable predictors of follow-up events, possibly due to low statistical power.
背景：发展中国家医院出院的儿童存在较高的发病率和死亡率风险。然而，很少有数据描述发展中国家农村门诊中心出院的儿童的这些结局。
目的：本探索性研究旨在确定乌干达农村卫生中心就诊并出院的儿童中近期和随访发病率和死亡率的预测因素。
方法：研究人员从乌干达西南部的一个农村卫生中心连续招募了 0-12 岁的有照顾者陪同的就诊儿童。研究护士收集了基线变量，记录了转诊、住院或死亡等结局（近期结局）。还确定了在就诊后 30 天内发生的死亡、住院和寻求医疗服务（随访结局）。采用单变量逻辑回归分析识别与近期结局和随访结局相关的基线变量。
结果：在四个月的招募期间，共纳入了 717 名儿童。有 85 例（11.9%）出现近期结局（10.1%住院，2.2%转诊，无死亡）。47 例（7.8%）在就诊后 30 天内发生（7.3%向医疗服务提供者寻求治疗，1.5%住院，0.5%死亡）。与近期结局相关的变量包括距离卫生中心 30 分钟以上、年龄大于 5 岁、就诊前曾服用抗疟药、就诊前曾看过社区卫生工作者、呼吸频率或体温升高、体重年龄 Z 评分降低或血氧饱和度降低。这些变量与随访结局无关。
结论：乌干达西南部农村卫生中心就诊的儿童死亡率和随后的住院率在就诊后随访期间低于 2%。在同一时期，约 7%的儿童出现了其他类型的医疗服务寻求行为。有几个变量与近期结局相关，但没有随访结局的可靠预测因素，这可能是由于统计效力较低。
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