Iron deficiency anemia and child mortality are public health problems requiring urgent attention. However, the degree to which iron deficiency anemia contributes to child mortality is unknown. Here, we utilized an exhaustive article search and screening process to identify articles containing both anemia and mortality data for children aged 28 days to 12 years. We then estimated the reduction in risk of mortality associated with a 1-g/dL increase in hemoglobin (Hb). Our meta-analysis of nearly 12,000 children from six African countries revealed a combined odds ratio of 0.76 (0.62–0.93), indicating that for each 1-g/dL increase in Hb, the risk of death falls by 24%. The feasibility of a 1-g/dL increase in Hb has been demonstrated via simple iron supplementation strategies. Our finding suggests that ~1.8 million deaths in children aged 28 days to five years could be avoided each year by increasing Hb in these children by 1 g/dL.

The Impact of Anemia on Child Mortality: An Updated Review

Objectives 
Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death.


Search Strategy 
MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion.


Results 
Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%–18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality.


Conclusions 
The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.

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Pediatric Post-Discharge Mortality in Resource Poor Countries: A Systematic Review

OBJECTIVE: To explore excess paediatric mortality after discharge from Kilifi District Hospital, Kenya, and its duration and risk factors. METHODS: Hospital and demographic data were used to describe post-discharge mortality and survival probability in children aged -4 but 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. CONCLUSION: Hospital 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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Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis

Anaemia, iron deficiency and susceptibility to infections.

Introduction The Integrated Management of Childhood Illness (IMCI) programme and inpatient guidelines of the World Health Organization (WHO) aim to standardize and improve the care of critically ill children at health facilities across Africa. (1-4) While the IMCI may reduce in-hospital child mortality, (5) its recommendations for the prevention and management of illness following discharge are based on limited evidence from the field and are rarely implemented. Several studies from developing countries have shown that children admitted to hospital and discharged alive are at increased risk of death for 12 months following discharge when compared with similar children in the community. Furthermore, malnutrition, anaemia, hypoxaemia, longer hospitalization and discharge against medical advice exacerbate this risk. (6-12) Additional data are needed to guide the development of strategies for effective follow-up care that will reduce post-discharge mortality. In Kilifi district, Kenya, infant and child mortality have dropped sharply in recent years, yet only one third of child deaths occur in hospital and access to hospital care for severely ill children is poor. (13) Previous data suggest that children who are discharged from hospital have a higher risk of dying during the 12-month period following discharge than comparable children in the community and that diarrhoea is a significant predictor of excess mortality. (6) In this study we sought to determine whether hospital admission could be characterized as an acute event with an impact on short-term mortality or as a marker of chronic frailty associated with an increased risk of dying over the longer term. We analysed 5 years of linked demographic and paediatric hospital surveillance data in a rolling cohort of approximately 111000 children aged less than 15 years at any one time, with detailed clinical and laboratory information available for all admissions. To guide hospital discharge policies and focus outpatient follow-up on high-risk groups, we estimated the burden and duration of excess mortality associated with hospital discharge and identified demographic and clinical risk factors for death in the post-discharge period. Methods This study was conducted in Kilifi district, a poor, rural area on the Indian Ocean coast of Kenya. The KEMRI/Wellcome Trust Research Programme has conducted laboratory, clinical and epidemiologic research in Kilifi for two decades. Kilifi District Hospital (KDH) in Kilifi town provides primary care and inpatient referral services for the entire district, following national and WHO management guidelines. The Kilifi Health and Demographic Surveillance Study (KHDSS) collects information on births, deaths and migrations in a population of 240 000 people residing in an 891 [km.sup.2] area around KDH. Beginning in April 2002, all patients hospitalized in the paediatric ward or paediatric high-dependency unit at the KDH had their hospital records, including standard clinical and laboratory data, linked to their demographic records with a unique personal identifier. The linked hospital and demographic databases enable us to monitor life events after hospital discharge for residents of the Health and Demographic Surveillance Study (HDSS) area. This analysis included all children

Excess Child Mortality after Discharge from Hospital in Kilifi, Kenya: A Retrospective Cohort analysis/Surmortalite Infantile Apres la Sortie De L'hopital De Kilifi, Au Kenya: Une Analyse De Cohorte retrospective/Sobremortalidad Infantil Tras El Alta De Un Hospital En Kilifi, Kenia: Analisis Retrospectivo De Cohortes

Background
Severe anaemia is a common, frequently fatal, condition in African children admitted to hospital, but its long term outcome is unknown. Early reports that survivors may be at risk of additional late morbidity and mortality may have significant implications for child survival in Africa. We assessed the short and long term outcome of severe anaemia in Malawian children and identified potential risk factors for death and further severe anaemia.

/pdf/long-term-outcome-of-severe-anaemia-in-malawian-children-5cgrh08u2d.pdf

Kondwani Ng’oma

Papers

Long Term Outcome of Severe Anaemia in Malawian Children