A new study by the Lancet Global Health has found that most children under five in sub-Saharan African countries, including Nigeria, face the highest rate of mortality due to gaps in the follow-up care they receive after hospital discharge.
It was observed that current care practices are fraught with shortcomings such as inpatient management of common syndromes and limited outpatient guidance on a community-based approach for managing children following hospital discharge.
Most deaths were attributed to avoidable disorders including severe sepsis, pneumonia, diarrhoea, and malnutrition, despite receiving care as recommended by current guidelines of the World Health Organization (WHO) and national guidelines.
To investigate mortality during the first 30 days of hospital admission and within 180 days of hospital discharge, the Lancet Global Health, in partnership with Childhood Acute Illness and Nutrition Network, enrolled 3, 101 children aged two to 23 months.
They all had acute illnesses from nine rural and urban hospitals across six sub-Saharan African and south Asian countries and were divided by nutritional status and level of wasting.
Wasting, according to WHO, indicates severe weight loss. It usually occurs when a person has not had food of adequate quality and quantity or they have had frequent or prolonged illnesses.
The study found that one in every 10 children, 350 or 11.3 percent died. Two-thirds or 66.9 percent died within 30 days of hospital admission and half, 168 or 48 percent died within 180 days of hospital discharge.
It also detected a disproportionately high mortality rate among children with severe wasting.
While the authors say numerous psychosocial factors link the risk of death to nutritional status and severity of illness, other evidence noted also shows that post-discharge mortality equally comes result from reduced access to healthcare.
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The study said: “Underlying medical and nutritional status are syndromes of compounding adverse effects from the interaction of disease with a history of structural, social, and economic inequality.
“Therefore, recognising and addressing the social determinants of child nutritional status is a crucial first step in lowering child mortality.”
The report further suggests it is necessary to identify the biomedical factors that contribute to the malnutrition that leads to post-discharge child mortality to present a complete picture of the problem and to develop effective interventions.
However, the authors admit that referring all discharged children for post-hospital evaluation to prevent relapse and for continuous monitoring may not be feasible in resource-limited countries like Nigeria.
Instead, they suggest that risk selection is used as a potential tool for identifying children who are at high risk of mortality and for effective allocation of resources to those with the greatest need.
They recommend that the discharge planning process needs to be strengthened, with referral mechanisms that better identify and engage with children and families who need additional support.
They clamour for primary and community health systems to be strengthened to promote preventive services and urged that more be done to validate predictive models of post-discharge risk and the evidence-based interventions that reduce child mortality.
In 2019, an estimated 5.2 million children died before reaching age of five, with 2.4 million dying within the first 28 days of life (the neonatal period), according to the 2021 World Health Statistics report by WHO.
Although under-five and neonatal mortality rates have declined significantly over the past 30 years, from 93 per 1, 000 live births in 1990 to 38 per 1000.
But most of the under-five deaths were concentrated in sub-Saharan Africa, Central and Southern Asia, which together accounted for more than 80 percent of deaths in 2019.
The lowest levels of child mortality have been achieved in upper-middle-income countries.
122 countries and territories have already met the SDG target for under-five mortality and 20 countries are expected to do so by 2030.
