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- W3201549852 abstract "BACKGROUND: Despite global child mortality reductions, children in low- and middle-income settings remain at unacceptably high risk of death during and following acute illness. Clinical and anthropometric predictors have been explored but a more comprehensive epidemiological understanding of acute illness-associated mortality and its multifactorial precursors is needed to inform effective intervention strategies. METHODS: We enrolled a cohort of acutely ill children aged 2-23 months admitted to nine hospitals in sub-Saharan Africa and South Asia, stratified by anthropometry. We assisted sites to manage children in line with guidelines. Co-primary outcomes were mortality within 30-days from admission and post-discharge mortality within 180-days from discharge. A priori exposure domains, including demographics, clinical and anthropometric characteristics at admission and discharge, and child-, caregiver- and household-level characteristics, were examined in regression and structural equation survival models (SEM).FINDINGS: Of 3101 participants median age 11 months, 1218 were severely wasted/kwashiorkor, 763 moderately wasted and 1120 were not wasted. Overall, 350 children died; 182 (52%) inpatient deaths; 234 (67%) within 30-days from admission; and 168 (48%) within 180-days post-discharge. The proportion of children who died post-discharge was relatively preserved across nutritional strata. 90 ( 54%) post-discharge deaths occurred at home. In SEM, anthropometry, HIV and adverse caregiver characteristics were directly and independently associated with 30-day and post-discharge mortality. Child-level nutritional exposures acted indirectly through anthropometry on both 30-day and post-discharge mortality. Illness severity and access to healthcare were directly associated only with 30-day mortality. Underlying medical conditions, clinical signs at discharge and discharge against medical advice were independently and directly associated with post-discharge mortality.INTERPRETATION: Among hospitalised children in Africa and South Asia, almost half of mortality occurs post-discharge. A fundamental shift to a more holistic risk-based approach to inpatient and post-discharge management is needed to further reduce mortality.FUNDING: The Bill & Melinda Gates Foundation [OPP1131320].DECLARATION OF INTERESTS: All contributors declare no conflict of interest.ETHICS APPROVAL STATEMENT: Ethical approval was obtained from the Oxford University Tropical Research Ethics Committee and ethics committees at all participating institutions.TRIAL REGISTRATION: This cohort study was registered at ClinicalTrials.gov: NCT03208725." @default.
- W3201549852 created "2021-09-27" @default.
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- W3201549852 date "2021-09-08" @default.
- W3201549852 modified "2023-09-28" @default.
- W3201549852 title "Childhood Mortality During and After Acute Illness in Africa and S. Asia: A Cohort Study" @default.
- W3201549852 hasPublicationYear "2021" @default.
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