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A6307 - Predictors of Post-Discharge Outcomes and Care-Seeking Behaviors among Children with Acute Infectious Illness in Southwestern Uganda
Author Block: P. P. Moschovis1, J. M. Blake2, A. K. Liebman3, E. Kumbakumba4, M. O. Wiens5; 1Pediatric Global Health/Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States, 2University of Maryland School of Medicine, Baltimore, MD, United States, 3Pediatric Global Health, Massachusetts General Hospital, Boston, MA, United States, 4Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda, 5Center for International Child Health, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Rationale Substantial progress has been made in reducing the under-5 mortality rate among children (U5MR). Despite the progress, in Sub-Saharan Africa the U5MR continues to be elevated largely due to sepsis-related deaths. Our previous work demonstrated that post-discharge and in-hospital mortality rates among children with sepsis are similar yet little is known about the predictors of health outcomes and care-seeking behaviors following hospital discharge. This study aims to understand predictors of post-discharge outcomes and care-seeking behaviors among children in Southwest Uganda.
Methods Children 6 months to 5 years of age with a proven or suspected acute infectious illness who presented to one of two hospitals in Mbarara, Uganda were enrolled in a prospective cohort study. Following discharge from the hospital, children received telephone and/or in person follow-up visits at 2, 4, and 6 months. During follow-up, information concerning mortality, readmission, recurrence of illness, and care-seeking behaviors were asked. Utilizing these data, geospatial, univariate and multivariate logistic regression analyses were performed to determine geographical, clinical, sociodemographic predictors of post-discharge outcomes and care-seeking behaviors.
Results Of 1,307 children enrolled, 1,242 were discharged alive of whom 68 (5.5%) died in the following 6 months and 206 (16.6%) were readmitted. We found that each additional kilometer in distance from the nearest Level 3 Health Facility was associated with an increased odds of death (univariate OR 1.08 [95% CI 1.01-1.15 ]). A similar non-significant association was noted with distance the nearest health facility of any kind (OR 1.09 [95% CI 0.93-1.27]). Previous hospitalization within 7 days and 7-30 days increased odds of post-discharge readmission as compared to no hospitalization (OR 3.08 [95% CI 1.58-6.02] and OR 1.87 [95% CI 1.04-3.38], respectively). Predictors of care-seeking included age >24 months (OR 2.80 [95% CI 1.01-5.61]) and 1 kilometer increases in distance from the nearest health facility (OR 1.23 [95% CI 1.01-1.50]). Caregivers who described their child has having been “very sick” (compared to “a little sick”) post-discharge were much less likely to have sought care during that period of follow-up (OR 0.11 [95% CI 0.04-0.32]).
Conclusion We identified several predictors of post-discharge mortality, readmission, and care-seeking behavior among children with sepsis in Uganda, including distance from a health facility and perception of severity of illness. These findings can guide the development of targeted post-discharge community-based interventions and health system structuring to reduce U5MR and morbidity in Sub-Saharan Africa.