Mukasa Oscar, Masanja Honorati, DeSavigny Don, Schellenberg Joanna
Ifakara Health Institute (IHI), PO Box 78373, Dar es Salaam, Tanzania.
Swiss Tropical and Public Health Institute (Swiss TPH), Socinstrasse, 57, Postfach CH 4002, Basel, Switzerland.
Emerg Themes Epidemiol. 2021 Mar 18;18(1):4. doi: 10.1186/s12982-021-00094-4.
To illustrate the public health potential of linking individual bedside data with community-based household data in a poor rural setting, we estimated excess pediatric mortality risk after discharge from St Francis Designated District Hospital in Ifakara, Tanzania.
Linked data from demographic and clinical surveillance were used to describe post-discharge mortality and survival probability in children aged < 5 years, by age group and cause of admission. Cox regression models were developed to identify risk factors.
Between March 2003 and March 2007, demographic surveillance included 28,910 children aged 0 to 5 years and among them 831 (3%) were admitted at least once to the district hospital. From all the children under the demographic surveillance 57,880 person years and 1381 deaths were observed in 24 months of follow up. Survivors of hospital discharge aged 0-5 years were almost two times more likely to die than children of the same age in the community who had not been admitted (RR = 1.9, P < 0.01, 95% CI 1.6, 2.4). Amongst children who had been admitted, mortality rate within a year was highest in infants (93 per 1000 person years) and amongst those admitted due to pneumonia and diarrhoea (97 and 85 per 1000 person years respectively). Those who lived 75 km or further from the district hospital, amongst children who were admitted and survived discharge from hospital, had a three times greater chance of dying within one year compared to those living within 25 km (adjusted HR 3.23, 95% CI 1.54,6.75). The probability of surviving the first 30 days post hospitalization was 94.4% [95% CI 94.4, 94.9], compared to 98.8% [95% CI 97.199.5] in non-hospitalized children of the same age in the commuity.
This study illustrates the potential of linking health related data from facility and household levels. Our results suggest that families may need additional support post hospitalization.
为了说明在贫穷农村地区将个体床边数据与社区家庭数据相联系的公共卫生潜力，我们估算了坦桑尼亚伊法卡拉圣弗朗西斯指定地区医院出院后儿童的额外死亡风险。
利用人口统计学和临床监测的关联数据，按年龄组和入院原因描述5岁以下儿童出院后的死亡率和生存概率。建立Cox回归模型以识别风险因素。
2003年3月至2007年3月期间，人口监测涵盖了28,910名0至5岁儿童，其中831名（3%）至少有一次入住地区医院。在人口监测的所有儿童中，随访24个月观察到57,880人年和1381例死亡。0至5岁出院幸存者死亡的可能性几乎是非住院同龄儿童的两倍（风险比=1.9，P<0.01，95%置信区间1.6,2.4）。在入院儿童中，婴儿的一年内死亡率最高（每1000人年93例），因肺炎和腹泻入院的儿童中死亡率分别为每1000人年97例和85例。在入院并存活出院的儿童中，居住在距离地区医院75公里或更远的儿童在一年内死亡的几率是居住在25公里以内儿童的三倍（调整后风险比3.23，95%置信区间1.54,6.75）。住院后前30天存活的概率为94.4%[95%置信区间94.4,94.9]，而社区中同龄非住院儿童的这一概率为98.8%[95%置信区间97.1,99.5]。
本研究说明了将机构层面和家庭层面的健康相关数据相联系的潜力。我们的结果表明，家庭在患儿出院后可能需要额外的支持。
