• Jennifer C Moïsi, Hellen Gatakaa, James A Berkley, Kathryn Maitland, Neema Mturi, Charles R Newton, Patricia Njuguna, James Nokes, John Ojal, Evasius Bauni, Benjamin Tsofa, Norbert Peshu, Kevin Marsh, Thomas N Williams, and J Anthony G Scott.
• KEMRI/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 Kenya. jmoisi@kilifi.kemri-wellcome.org
• Bull. World Health Organ. 2011 Oct 1; 89 (10): 725-32, 732A.

ObjectiveTo explore excess paediatric mortality after discharge from Kilifi District Hospital, Kenya, and its duration and risk factors.MethodsHospital and demographic data were used to describe post-discharge mortality and survival probability in children aged < 15 years, by age group and clinical syndrome. Cox regression models were developed to identify risk factors.FindingsIn 2004-2008, approximately 111,000 children were followed for 555,000 person-years. We analysed 14,971 discharges and 535 deaths occurring within 365 days of discharge. Mortality was higher in the post-discharge cohort than in the community cohort (age-adjusted rate ratio, RR: 7.7; 95% confidence interval, CI: 6.6-8.9) and declined little over time. An increased post-discharge mortality hazard was found in children aged < 5 years with the following: weight-for-age Z score < -4 (hazard ratio, HR: 6.5); weight-for-age Z score > -4 but < -3 (HR: 3.4); hypoxia (HR: 2.3); bacteraemia (HR: 1.8); hepatomegaly (HR: 2.3); jaundice (HR: 1.8); hospital stay > 13 days (HR: 1.8). Older age was protective (reference < 1 month): 6-23 months, HR: 0.8; 2-4 years, HR: 0.6. Children with at least one risk factor accounted for 545 (33%) of the 1655 annual discharges and for 39 (47%) of the 83 discharge-associated deaths.ConclusionHospital admission selects vulnerable children with a sustained increased risk of dying. The risk factors identified provide an empiric basis for effective outpatient follow-up.

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