肯尼亚贫血和疟原虫血症儿童的住院和出院后死亡率：一项队列研究。

Inpatient and postdischarge mortality among children with anaemia and malaria parasitaemia in Kenya: a cohort study.

机构信息

KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya

The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya.

出版信息

BMJ Glob Health. 2024 Oct 21;9(10):e016600. doi: 10.1136/bmjgh-2024-016600.

DOI:10.1136/bmjgh-2024-016600

PMID:39433400

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11499763/

Abstract

BACKGROUND

Anaemia and malaria are leading causes of paediatric hospitalisation and inpatient mortality in sub-Saharan Africa. However, there is limited empirical data on survival following hospital discharge. We aimed to estimate independent effects of anaemia and malaria parasitaemia on inpatient and 1 year postdischarge mortality among Kenyan children.

METHODS

A retrospective cohort study among children admitted to Kilifi County Hospital (KCH) from 2010 to 2019 and followed-up for 1 year postdischarge in Kilifi Health and Demographic Surveillance System (KHDSS). The main exposures were anaemia and malaria parasitaemia at the time of hospital admission while inpatient and 1 year postdischarge mortality were the outcomes.

RESULTS

We included 9431 admissions among 7578 children (43% girls), median (IQR) age 19 (9.9‒23) months. 2069 (22%), 3893 (41%) and 1140 (12%) admissions had mild, moderate and severe anaemia, whereas 366 (3.9%), 779 (8.3%) and 224 (2.4%) had low, medium and high malaria parasitaemia, respectively. Overall, there were 381 (4.0%) inpatient deaths: 317/381 (83%) and 47/381 (12%) among children with any level of anaemia and malaria parasitaemia, respectively. Moderate and severe, but not mild anaemia, were positively associated with inpatient death. Low and high level parasitaemia were positively associated with inpatient mortality, while medium level parasitaemia was negatively associated. There were 228 (3.1%) postdischarge deaths: 32.8 (95% CI 28.8‒37.3) deaths/1000 child-years. 180/228 (79%) deaths occurred within 6 months after index discharge and 99/228 (43%) occurred in the community. Overall, 180/228 (79%) and 10/228 (4.4%) postdischarge deaths occurred among children with any level of anaemia and malaria parasitaemia, respectively. Severe anaemia was positively associated with postdischarge mortality (adjusted HR 1.94 (95% CI 1.11‒3.40)), while medium level parasitaemia was negatively associated.

CONCLUSION

Interventions to create awareness of postdischarge risks, improve uptake of existing interventions and improved discharge processes targeting high-risk groups such as children admitted with severe anaemia, need to be prioritised.

摘要

背景

在撒哈拉以南非洲，贫血和疟疾是导致儿童住院和住院死亡的主要原因。然而，关于出院后生存的经验数据有限。本研究旨在评估肯尼亚儿童住院期间和出院后 1 年的死亡率与贫血和疟疾寄生虫血症的独立影响。

方法

这是一项回顾性队列研究，纳入了 2010 年至 2019 年期间在基利菲县医院（KCH）住院的儿童，并在基利菲健康和人口监测系统（KHDSS）中进行了出院后 1 年的随访。主要暴露因素为入院时的贫血和疟疾寄生虫血症，住院期间和出院后 1 年的死亡率为结局。

结果

本研究纳入了 7578 名儿童中的 9431 例住院（43%为女孩），中位（IQR）年龄为 19（9.9-23）个月。2069 例（22%）、3893 例（41%）和 1140 例（12%）的住院儿童患有轻度、中度和重度贫血，而 366 例（3.9%）、779 例（8.3%）和 224 例（2.4%）的住院儿童患有低、中、高疟疾寄生虫血症。共有 381 例（4.0%）住院死亡：317/381（83%）和 47/381（12%）的死亡分别发生在任何贫血和疟疾寄生虫血症水平的儿童中。中度和重度贫血与住院死亡呈正相关，但轻度贫血则无相关性。低水平和高水平寄生虫血症与住院死亡率呈正相关，而中水平寄生虫血症则呈负相关。共有 228 例（3.1%）出院后死亡：228/228（3.1%）死亡/1000 儿童年。180/228（79%）的死亡发生在指数出院后 6 个月内，99/228（43%）发生在社区。总体而言，任何贫血和疟疾寄生虫血症水平的儿童出院后死亡率分别为 180/228（79%）和 10/228（4.4%）。严重贫血与出院后死亡率呈正相关（校正 HR 1.94（95%CI 1.11-3.40）），而中水平寄生虫血症则呈负相关。