Pediatric post-discharge mortality in resource-poor countries: A protocol for an updated systematic review and meta-analysis
More than 50 countries, mainly in Sub-Saharan Africa and South Asia, are not on course to meet the neonatal and under-five mortality target set by the Sustainable Development Goals (SDGs) for 2030. One important, yet neglected, aspect of child mortality is deaths occurring during the post-discharge period. For children in resource-poor countries, post-discharge mortality within the first several months after discharge is often as high as mortality during the initial admission, closely linked to underlying conditions such as malnutrition, HIV, and anaemia. These rates tend to be underreported and present a major oversight in efforts to reduce overall child mortality. This review will explore recurrent illness following discharge through determination of rates of, and risk factors for, paediatric post-discharge mortality in resource-poor settings.
Eligible studies will be retrieved using MEDLINE, EMBASE, and CINAHL databases, including only those with a post-discharge observation period of more than 7 days. Secondary outcomes include post-discharge mortality relative to in-hospital mortality, readmission rates, and pooled estimates of risk factors. A narrative synthesis and random-effects meta-analysis will quantify overall post-discharge mortality rates at the 6-month time point.
Post-discharge mortality contributes to global child mortality, with a greater burden of deaths occurring in resource-poor settings. Literature on child mortality has expanded over the last decade to focus on fatal outcomes post-discharge and associated risk factors. The results from this systematic review will inform current policy and interventions on the epidemiological burden of post-discharge mortality and morbidity following acute illness among children in resource-poor settings.
This article relates to R2HC funded study: Smart Discharges for refugee children: Improving hospital-to-community care transitions