Variation in and risk factors for paediatric inpatient all-cause mortality in a low income setting: data from an emerging clinical information network


BACKGROUND Hospital mortality data can inform planning for health interventions and may help optimize resource allocation if they are reliable and appropriately interpreted. However such data are often not available in low income countries including Kenya. METHODS Data from the Clinical Information Network covering 12 county hospitals' paediatric admissions aged 2-59 months for the periods September 2013 to March 2015 were used to describe mortality across differing contexts and to explore whether simple clinical characteristics used to classify severity of illness in common treatment guidelines are consistently associated with inpatient mortality. Regression models accounting for hospital identity and malaria prevalence (low or high) were used. Multiple imputation for missing data was based on a missing at random assumption with sensitivity analyses based on pattern mixture missing not at random assumptions. RESULTS The overall cluster adjusted crude mortality rate across hospitals was 6 · 2% with an almost 5 fold variation across sites (95% CI 4 · 9 to 7 · 8; range 2 · 1% - 11 · 0%). Hospital identity was significantly associated with mortality. Clinical features included in guidelines for common diseases to assess severity of illness were consistently associated with mortality in multivariable analyses (AROC =0 · 86). CONCLUSION All-cause mortality is highly variable across hospitals and associated with clinical risk factors identified in disease specific guidelines. A panel of these clinical features may provide a basic common data framework as part of improved health information systems to support evaluations of quality and outcomes of care at scale and inform health system strengthening efforts.

DOI: 10.1186/s12887-017-0850-8

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@inproceedings{Gathara2017VariationIA, title={Variation in and risk factors for paediatric inpatient all-cause mortality in a low income setting: data from an emerging clinical information network}, author={David Gathara and Lucas Malla and Philip Ayieko and Stella Karuri and Rachel Nyamai and Grace Irimu and Michael Boele van Hensbroek and Elizabeth Allen and Mike English and David Githanga and Fred Were and Barnabas Kigen and Samuel NgarNgar and Nick Aduro and Rachel Inginia and Beatrice Mutai and Grace Ochieng and Lydia Thuranira and Francis Kanyingi and Margaret Kuria and Sam Otido and Kigondu Rutha and Peris Njiiri and Martin Chabi and Charles Nzioki and Joan Ondere and Caren Emadau and Cecelia Mutiso and Naomi Muinga and Michael Bitok and Timothy Tuti and Boniface Makone and Wycliffe Nyachiro and George Mbevi and Thomas Julius and Susan Gachau and Morris Ogero}, booktitle={BMC pediatrics}, year={2017} }