Paediatric survival and re-admission risks following hospitalization on the Kenyan Coast

The district general hospital (DGH) is a common feature of health service p rovision in many developing countries. We have used linked demographic and clinical surveillance in a rural community located close to a DGH on the Ke nyan coast to define the use and public health significanceof essencial cli nical services provided by it. Of a birth cohort of over 4000 children foll owed for approximately 6 years, abouc a third were admitted to hospital at least once. Significantly more children admitted with major infectious dise ases such as malaria and acute respiratory tract infections were readmitted with the same condicion during the surveillance period than would have bee n expected by chance. Among surviving admissions, mortality post-discharge was significantly higher than in the cohort which had not been admitted wit hin 3, 6 and 12 months. Most of the patients who died after discharge had b een admitted with a diagnosis of gastroenteritis. Most children admitted to the DGH survive hospitalization and the remaining period of childhood. Des pite no clinical trial evidence to support the claim, it seems reasonable t o assume that in the absence of intensive ulinical managenlent provided by a DGH, a significant proportion of these children would not have survived. However, the DGH is able to define a group of at-risk children who re-prese nt with severe complications of infectious disease, and of these several ma y have underlying conditions not amenable to DGH intervention and continue to have a poor prognosis. Both groups of children represent statistically s ignificant subsets of a rural paediatric community and the future organizat ion and co-ordination of DGH and primary care services need to work in unis on to strengthen the service needs of children at risk.The district general hospital (DGH) is a common feature of health service provision in many dev eloping countries. We have used linked demographic and clinical surveillanc e in a rural community located close to a DGH on the Kenyan coast to define the use and public health significance of essential clinical services prov ided by it. Of a birth cohort of over 4000 children followed for approximat ely 6 years, about a third were admitted to hospital at least once. Signifi cantly more children admitted with major infectious diseases such as malari a and acute respiratory tract infections were readmitted with the same cond ition during the surveillance period than would have been expected by chanc e. Among surviving admissions, mortality postdischarge was significantly hi gher than in the cohort which had not been admitted within 3, 6 and 12 mont hs. Most of the patients who died after discharge had been admitted with a diagnosis of gastroenteritis. Most children admitted to the DGH survive hos pitalization and the remaining period of childhood. Despite no clinical tri al evidence to support the claim, it seems reasonable to assume that in the absence of intensive clinical management provided by a DGH, a significant proportion of these children would not have survived. However, the DGH is a ble to define a group of at-risk children who re-present with severe compli cations of infectious disease, and of these several may have underlying con ditions not amenable to DGH intervention and continue to have a poor progno sis. Both groups of children represent statistically significant subsets of a rural paediatric community and the future organization and co-ordination of DGH and primary care services need to work in unison to strengthen the service needs of children at risk.