Child mortality: reducing death in low-income countries

Child mortality: reducing death in low-income countries
© iStock/EnolaBrain

According to ISGlobal, a simple algorithm could contribute to reducing the high rates of child mortality in the month following their hospital discharge.

A study led by the Barcelona Institute of Global Health (ISGlobal), in collaboration with the Manhiça Health Research Centre (CISM), Spain, found that the probability of dying in the first month after hospital discharge is high in Mozambique – particularly for babies under three months of age. The study also shows that an algorithm based on a series of simple clinical parameters can identify those children at higher risk of dying and that would therefore benefit from a proactive follow-up after their discharge. The application of these models could contribute to decreasing child mortality in low-income countries.

The race to reduce child mortality

Decreasing child mortality over the past 25 years, under five years of age, has been remarkable but insufficient. In low-income countries, infants are at an increased risk of dying following hospitalisation, regardless of their illness, with an estimated risk ranging between 3 and 13% in the month following discharge.

Therefore, the challenge is to identify those children that are at a higher risk in order to follow them up closely after discharge, and thereby avoid a considerable number of paediatric deaths.

Lola Madrid, ISGlobal researcher and first author of the study explains: “This is the largest study performed to date to evaluate mortality three months following hospital discharge in a rural area of a low-income country.”

Average mortality after discharge is high

More than 20,000 paediatric hospital admissions over almost 20 years were analysed in the district hospital of Manhiça, Mozambique, where almost half of the population is under 15 years of age. The researchers determined mortality during the first, second and third month after hospital discharge, and looked for indicators that would allow to identify children at higher risk of dying.

With half of the deaths occurring within the first 30 days, the results show that the average child mortality after discharge is still high (3.6%). The risk is highest in babies under three months of age and decreases progressively with age.

This study also acts as a series of clinical parameters i.e. analysing malnutrition, diarrhoea, clinical pneumonia etc., therefore allowing to identify those children at highest mortality risk. Using all or some of these variables, the team used a series of predictive models capable of identifying up to 80% of children at risk of dying after discharge.

As a result, the children identified could benefit from a close follow-up during the first 30 days by community health workers or receive preventive antimicrobial therapies.

Quique Bassat, ICREA researcher and study coordinator concludes: “If these simple models, based on easy-to-obtain parameters like those used in our study, are validated in other contexts, they could represent a valuable tool to save neonatal and infant lives in countries with a high burden of child mortality.”

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