750 - The Burden and Causes of Post-Discharge Mortality in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network

Publication Number: 750.6582

Rosauro Varo, Barcelona Institute for Global Health, Barcelona, Catalonia, Spain; Kaitlin Cole, Emory University School of Medicine, Decatur, GA, United States; Zachary J.. Madewell, CDC, San Juan, N/A, Puerto Rico; Jaime Fanjul Iglesias, ISGlobal, Madrid, Madrid, Spain; Lola Madrid, London School of Hygiene and Tropical Medicine, London, England, United Kingdom; Kitiezo Aggrey. Igunza, Kenya Medical Research Institute, Kisumu, Nyanza, Kenya; Nega Assefa, Haramaya University, Harar, Hareri Hizb, Ethiopia; Dr. Haleluya Leulseged, Haramaya University, College Of Health And Medical Science, Harar, Hareri Hizb, Ethiopia; Quique Bassat, ISGlobal, Barcelona, Catalonia, Spain; Cynthia G.. Whitney, Emory University, Atlanta, GA, United States; Chris A. Rees, Emory University School of Medicine, Atlanta, GA, United States

Background: Rates of post-hospital discharge mortality (PDM) within six months after hospitalization among young children in low- and middle-income countries (LMICs) are as high as 3 to 18% and may outpace rates of in-hospital mortality in some settings. However, an understanding of the definitive causes of PDM among young children is lacking.

Objective: To determine timing of deaths after hospital discharge, to compare causes of PDM to cases that did not have antecedent hospitalizations, and to identify risk factors associated with PDM compared to deaths among children without preceding hospitalizations

Design/Methods: We conducted a descriptive study using data from prospective childhood mortality surveillance in eight sites in LMICs in the Child Health and Mortality Prevention Surveillance (CHAMPS) network (Table). We included deaths among young children aged 0-59 months enrolled in CHAMPS between 2016 and 2023. We excluded deaths among neonates that occurred after delivery without discharge and deaths with insufficient data to determine prior hospitalization. We reviewed CHAMPS narratives to identify antecedent hospitalizations within 6 months of death. We used causes of death determined postmortem by expert panels reviewing minimally invasive tissue sampling and available clinical data. We constructed a multivariable logistic regression model to identify characteristics at the time of death associated with PDM and compared causes of PDM to causes of deaths without antecedent hospitalizations.

Results: Among 6,998 CHAMPS cases, 2,138 died within hours of birth or before discharge after delivery and 482 cases had insufficient data. Thus, 4,378 cases were included; 733 (16.7%) were cases of PDM. The median time from discharge to death was 7 days (IQR 4, 15) for neonates and 60 days (IQR 29, 125) for infants (P < 0.001). Infants aged 1-11 months (adjusted odds ratio [aOR]1.30, 95% CI 1.05, 1.62) and cases with a weight-for-age z score <-3 (aOR 2.71 95% CI 2.05, 3.60) had greater adjusted odds of PDM (Table). There was substantial variation in frequency of PDM by site. The most common causes of PDM differed from causes of death in cases without antecedent hospitalizations (Figure).

Conclusion(s): Preceding hospitalizations were common among young children who died across eight sites in sub-Saharan Africa and South Asia. Infants and those with malnutrition are populations in need of closer medical follow-up and targeted interventions to reduce mortality from common causes of PDM including sepsis and lower respiratory tract infections.

Table. Description of cases included in the analyses of post-discharge mortality in the Child Health and Mortality Prevention Surveillance (CHAMPS) network


Figure. Comparison of causes of death among young children from 2016-2023 with preceding hospitalization ≤6 months before death to those without preceding hospitalizations (N=2,054)


Table. Description of cases included in the analyses of post-discharge mortality in the Child Health and Mortality Prevention Surveillance (CHAMPS) network


Figure. Comparison of causes of death among young children from 2016-2023 with preceding hospitalization ≤6 months before death to those without preceding hospitalizations (N=2,054)