{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:13:54Z","timestamp":1791562434223,"version":"4.3.4"},"reference-count":32,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Although the burden of postdischarge mortality (PDM) in low-income settings appears to be significant, no clear recommendations have been proposed in relation to follow-up care after hospitalization. We aimed to determine the burden of pediatric PDM and develop predictive models to identify children who are at risk for dying after discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>Deaths after hospital discharge among children aged &amp;lt;15 years in the last 17 years were reviewed in an area under demographic and morbidity surveillance in Southern Mozambique. We determined PDM over time (up to 90 days) and derived predictive models of PDM using easily collected variables on admission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Overall PDM was high (3.6%), with half of the deaths occurring in the first 30 days. One primary predictive model for all ages included young age, moderate or severe malnutrition, a history of diarrhea, clinical pneumonia symptoms, prostration, bacteremia, having a positive HIV status, the rainy season, and transfer or absconding, with an area under the curve of 0.79 (0.75\u20130.82) at day 90 after discharge. Alternative models for all ages including simplified clinical predictors had a similar performance. A model specific to infants &amp;lt;3 months old was used to identify as predictors being a neonate, having a low weight-for-age z score, having breathing difficulties, having hypothermia or fever, having oral candidiasis, and having a history of absconding or transfer to another hospital, with an area under the curve of 0.76 (0.72\u20130.91) at day 90 of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Death after discharge is an important although poorly recognized contributor to child mortality. A simple predictive algorithm based on easily recognizable variables could readily be used to identify most infants and children who are at a high risk of dying after discharge.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2018-0606","type":"journal-article","created":{"date-parts":[[2018,12,14]],"date-time":"2018-12-14T13:26:16Z","timestamp":1544793976000},"source":"Crossref","is-referenced-by-count":52,"title":["Postdischarge Mortality Prediction in Sub-Saharan Africa"],"prefix":"10.1542","volume":"143","author":[{"given":"Lola","family":"Madrid","sequence":"first","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aina","family":"Casellas","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charfudin","family":"Sacoor","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloren\u00e7","family":"Quint\u00f3","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Sitoe","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosauro","family":"Varo","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sozinho","family":"Ac\u00e1cio","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tacilta","family":"Nhampossa","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Massora","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betuel","family":"Siga\u00faque","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inacio","family":"Mandomando","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Cousens","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Men\u00e9ndez","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"},{"name":"Centro de Investigacion Biomedica en Red (CIBER) de Epidemiolog\u00eda y Salud P\u00fablica, Instituto de Salud Carlos III, Madrid, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Alonso","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eusebio","family":"Macete","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quique","family":"Bassat","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"Hospital Cl\u00ednic de Barcelona, Barcelona Institute for Global Health and Universitat de Barcelona, Barcelona, Spain;"},{"name":"Instituci\u00f3 Catalana de Recerca i Estudis Avan\u00e7ats, Passeig Llu\u00eds Companys 23, Barcelona, Spain; and"},{"name":"Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de D\u00e9u and University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,1,1]]},"reference":[{"key":"2021121019571524400_B1","unstructured":"United Nations\n          . Child mortality estimates. 2017. Available at: www.childmortality.org\/index.php?r=site\/index. Accessed November 11, 2017"},{"key":"2021121019571524400_B2","doi-asserted-by":"crossref","unstructured":"United Nations\n          . Levels and trends in child mortality report 2015: new UN study released on September 9, 2015 reveals substantial progress in child mortality since 1990 but global MDG 4 target missed by wide margin. 2015. Available at: www.un.org\/en\/development\/desa\/population\/publications\/mortality\/child-mortality-report-2015.shtml. Accessed February 27, 2017","DOI":"10.18356\/8344d573-en"},{"key":"2021121019571524400_B3","volume-title":"Integrated Management of Childhood Illness: Distance Learning Course","author":"World Health Organization","year":"2014"},{"issue":"6","key":"2021121019571524400_B4","doi-asserted-by":"crossref","first-page":"e66698","DOI":"10.1371\/journal.pone.0066698","article-title":"Pediatric post-discharge mortality in resource poor countries: a systematic review.","volume":"8","author":"Wiens","year":"2013","journal-title":"PLoS One"},{"issue":"3","key":"2021121019571524400_B5","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1542\/peds.2007-3282","article-title":"Postdischarge follow-up of infants with congenital diaphragmatic hernia.","volume":"121","author":"Lally","year":"2008","journal-title":"Pediatrics"},{"issue":"2","key":"2021121019571524400_B6","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.ahj.2005.12.016","article-title":"Risk factors for deaths occurring within 30 days and 1 year after hospital discharge for cardiac surgery among pediatric patients.","volume":"152","author":"Chang","year":"2006","journal-title":"Am Heart J"},{"issue":"9","key":"2021121019571524400_B7","doi-asserted-by":"crossref","first-page":"e0137095","DOI":"10.1371\/journal.pone.0137095","article-title":"Child mortality after discharge from a health facility following suspected pneumonia, meningitis or septicaemia in rural Gambia: a cohort study.","volume":"10","author":"Chhibber","year":"2015","journal-title":"PLoS One"},{"issue":"9","key":"2021121019571524400_B8","doi-asserted-by":"crossref","first-page":"e107663","DOI":"10.1371\/journal.pone.0107663","article-title":"Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh.","volume":"9","author":"Chisti","year":"2014","journal-title":"PLoS One"},{"issue":"10","key":"2021121019571524400_B9","doi-asserted-by":"crossref","first-page":"725","DOI":"10.2471\/BLT.11.089235","article-title":"Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis.","volume":"89","author":"Moisi","year":"2011","journal-title":"Bull World Health Organ"},{"issue":"6399","key":"2021121019571524400_B10","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1136\/bmj.287.6399.1097","article-title":"Excess mortality among children discharged from hospital after treatment for diarrhoea in rural Bangladesh.","volume":"287","author":"Roy","year":"1983","journal-title":"Br Med J (Clin Res Ed)"},{"issue":"2","key":"2021121019571524400_B11","first-page":"144","article-title":"Long-term morbidity and mortality following hypoxaemic lower respiratory tract infection in Gambian children.","volume":"77","author":"West","year":"1999","journal-title":"Bull World Health Organ"},{"key":"2021121019571524400_B12","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2147\/CLEP.S35693","article-title":"Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality.","volume":"4","author":"Wiens","year":"2012","journal-title":"Clin Epidemiol"},{"issue":"11","key":"2021121019571524400_B13","doi-asserted-by":"crossref","first-page":"e009449","DOI":"10.1136\/bmjopen-2015-009449","article-title":"Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models.","volume":"5","author":"Wiens","year":"2015","journal-title":"BMJ Open"},{"issue":"6","key":"2021121019571524400_B14","doi-asserted-by":"crossref","first-page":"655","DOI":"10.4269\/ajtmh.1996.55.655","article-title":"Childhood mortality during and after hospitalization in western Kenya: effect of malaria treatment regimens.","volume":"55","author":"Zucker","year":"1996","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"2021121019571524400_B15","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1111\/j.1651-2227.2007.00562.x","article-title":"Increased mortality in the year following discharge from a paediatric ward in Bissau, Guinea-Bissau.","volume":"96","author":"Veirum","year":"2007","journal-title":"Acta Paediatr"},{"issue":"7625","key":"2021121019571524400_B16","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1136\/bmj.39345.467813.80","article-title":"Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial.","volume":"335","author":"Biai","year":"2007","journal-title":"BMJ"},{"issue":"3","key":"2021121019571524400_B17","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S1473-3099(11)70320-6","article-title":"Intermittent preventive therapy for malaria with monthly artemether-lumefantrine for the post-discharge management of severe anaemia in children aged 4-59 months in southern Malawi: a multicentre, randomised, placebo-controlled trial.","volume":"12","author":"Phiri","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"6","key":"2021121019571524400_B18","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1093\/tropej\/42.6.342","article-title":"Death in a diarrhoeal cohort of infants and young children soon after discharge from hospital: risk factors and causes by verbal autopsy.","volume":"42","author":"Islam","year":"1996","journal-title":"J Trop Pediatr"},{"issue":"2","key":"2021121019571524400_B19","first-page":"113","article-title":"Follow-up of children discharged from hospital after treatment for diarrhoea in urban Bangladesh.","volume":"38","author":"Stanton","year":"1986","journal-title":"Trop Geogr Med"},{"issue":"8","key":"2021121019571524400_B20","doi-asserted-by":"crossref","first-page":"e2903","DOI":"10.1371\/journal.pone.0002903","article-title":"Long term outcome of severe anaemia in Malawian children.","volume":"3","author":"Phiri","year":"2008","journal-title":"PLoS One"},{"issue":"4","key":"2021121019571524400_B21","doi-asserted-by":"crossref","first-page":"e000961","DOI":"10.1136\/bmjopen-2012-000961","article-title":"Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic\/hospital in Dhaka, Bangladesh.","volume":"2","author":"Ashraf","year":"2012","journal-title":"BMJ Open"},{"key":"2021121019571524400_B22","unstructured":"World Health Organization\n          . Global Health Observatory (GHO) data: under-five mortality. 2015. Available at: www.who.int\/gho\/child_health\/mortality\/mortality_under_five_text\/en\/. Accessed July 13, 2017"},{"issue":"10","key":"2021121019571524400_B23","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1111\/j.1468-1293.2012.01018.x","article-title":"High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey.","volume":"13","author":"Gonz\u00e1lez","year":"2012","journal-title":"HIV Med"},{"issue":"7","key":"2021121019571524400_B24","doi-asserted-by":"crossref","first-page":"e0132053","DOI":"10.1371\/journal.pone.0132053","article-title":"HIV incidence and spatial clustering in a rural area of southern Mozambique.","volume":"10","author":"Gonz\u00e1lez","year":"2015","journal-title":"PLoS One"},{"issue":"2","key":"2021121019571524400_B25","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/QAI.0000000000000019","article-title":"Impact of HIV exposure on health outcomes in HIV-negative infants born to HIV-positive mothers in Sub-Saharan Africa.","volume":"65","author":"Moraleda","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2021121019571524400_B26","volume-title":"Partnership for Maternal, Newborn & Child Health, World Health Organization. Countdown to 2015: Building a Future for Women and Children, Mozambique Country Reports","author":"World Health Organization","year":"2012"},{"issue":"5","key":"2021121019571524400_B27","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1093\/ije\/dyt148","article-title":"Profile: Manhi\u00e7a Health Research Centre (Manhi\u00e7a HDSS).","volume":"42","author":"Sacoor","year":"2013","journal-title":"Int J Epidemiol"},{"key":"2021121019571524400_B28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/1471-2458-9-67","article-title":"A 10 year study of the cause of death in children under 15 years in Manhi\u00e7a, Mozambique.","volume":"9","author":"Sacarlal","year":"2009","journal-title":"BMC Public Health"},{"key":"2021121019571524400_B29","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4899-4541-9","volume-title":"An Introduction to the Bootstrap","author":"Efron","year":"1993","edition":"1st ed"},{"issue":"9","key":"2021121019571524400_B30","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1017\/S1368980013001080","article-title":"Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique.","volume":"16","author":"Nhampossa","year":"2013","journal-title":"Public Health Nutr"},{"key":"2021121019571524400_B31","article-title":"Community-Based Care to Improve Maternal, Newborn, and Child Health","volume-title":"Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities","author":"Lassi","year":"2016","edition":"3rd ed."},{"issue":"7","key":"2021121019571524400_B32","doi-asserted-by":"crossref","first-page":"e464","DOI":"10.1016\/S2214-109X(16)30096-1","article-title":"Daily co-trimoxazole prophylaxis to prevent mortality in children with complicated severe acute malnutrition: a multicentre, double-blind, randomised placebo-controlled trial.","volume":"4","author":"Berkley","year":"2016","journal-title":"Lancet Glob Health"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-0606\/1076419\/peds_20180606.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2018-0606\/1076419\/peds_20180606.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T06:12:11Z","timestamp":1639203131000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/143\/1\/e20180606\/37279\/Postdischarge-Mortality-Prediction-in-Sub-Saharan"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,1]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,1]]},"published-print":{"date-parts":[[2019,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2018-0606","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,1]]},"article-number":"e20180606"}}