New study highlights high burden of post-discharge death among children hospitalized for sepsis in Uganda

July 5, 2023

Research recently published in the Lancet, shows that countries such as Uganda see as many deaths from sepsis after hospital discharge as during admission. The research team identified that the transition from hospital to community care is key to improving child survival in low-income countries.

“We’re showing that the post-discharge period for children in Africa who are hospitalized for sepsis is particularly devastating in terms of child mortality,” says Dr. Matthew Wiens, UBC professor and lead author of the study. “Most post-discharge deaths occur due to preventable causes such as pneumonia, malaria or diarrheal illness. Additionally, two-thirds of these deaths occur at home or in-transit to seeking care, meaning that most of these children die in the absence of any potentially life-saving hospital care.”

Dr. Wiens is an epidemiologist and public health researcher at BC Children’s Hospital and the Institute for Global Health as well as an assistant professor in the Faculty of Medicine at the University of British Columbia. Over the past decade his research team has co-developed a “Smart Discharges” program with Ugandan researchers, health workers, non-governmental organizations, and the Ministry of Health to improve discharge care. This includes a decades-long partnership with Holy Innocent’s Children’s Hospital in Mbarara, Uganda, which has served as a research and implementation site for Smart Discharges since 2014. The Smart Discharges approach uses prediction algorithms, digital tools, caregiver educational materials and a training program for health workers to improve discharge and follow-up of vulnerable children. This program is currently being embedded into routine care at several facilities in Uganda in partnership with the Ministry of Health, Walimu (a Uganda non-governmental organization), EMR developers, and other health care providers in Uganda.

“If the global players in child health wish to save the lives of more children, we need to better address the post-discharge period,” says Dr. Wiens. Previous research by Dr. Wiens and others has identified key factors that suggest a child might be more likely to die after hospital discharge, such as anemia, malnutrition or an HIV diagnosis. This new study is the largest to date to prospectively track a cohort of children discharged from hospital in a low-income country and pinpoint these risks. Crucially, the study’s design supported a more rigorous analysis than was previously possible, including an assessment of how a child’s age affects the identified factors.

“Malnutrition, for example, is a much bigger deal for younger kids. The younger the child, the more malnutrition impacts their risk during the post-hospital period,” says Dr. Wiens. “Whereas for anemia, the opposite is true, with older children who are severely anemic having a much higher risk of dying following hospital discharge.” The researchers hope these findings could be used to develop better guidelines to ensure that follow-up can become more child-centered as opposed to a one-size-fits-all approach, ultimately saving numerous lives during the transition from hospital to community care.

Thank you to Alan Worsley, Communications Specialist, at the BC Children's Research Institute, for contributing this story.

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First Nations land acknowledegement

Action on Sepsis operates on the traditional, ancestral, and unceded territory of the Coast Salish peoples — xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) Nations. We invite everyone to reflect on the traditional territories and land that they currently work and live on.

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