{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:33:39Z","timestamp":1787956419117,"version":"build-2784847793"},"reference-count":35,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged &lt; 5\u2009years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101\/3,639). The mortality by 6\u2009months after discharge (primary outcome) was 6.2% (159\/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), \u201cother conditions\u201d (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60\u20136.00, <jats:italic>P<\/jats:italic> &lt; 0.001) or severe anemia (HR = 2.55, 1.74\u20133.71, <jats:italic>P<\/jats:italic> &lt; 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21\u20130.53, <jats:italic>P<\/jats:italic> &lt; 0.001). The odds of dying by 6\u2009months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6\u2009months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0186","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T14:52:52Z","timestamp":1691419972000},"page":"704-712","source":"Crossref","is-referenced-by-count":9,"title":["Post-Discharge Risk of Mortality in Children under 5 Years of Age in Western Kenya: A Retrospective Cohort Study"],"prefix":"10.4269","volume":"109","author":[{"given":"Titus K.","family":"Kwambai","sequence":"first","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"},{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"},{"name":"Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Kariuki","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno R.","family":"Smit","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"},{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"},{"name":"Amsterdam Centre for Global Child Health, Emma Children\u2019s Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Nevitt","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Onyango","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Oneko","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sammy","family":"Khagayi","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron M.","family":"Samuels","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya;"},{"name":"Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary J.","family":"Hamel","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Laserson","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghna","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feiko O.","family":"ter Kuile","sequence":"additional","affiliation":[{"name":"Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;"},{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Br J Haematol","first-page":"690","article-title":"Severe acquired anemia in Africa: new concepts","volume":"154","author":"van Hensbroek","year":"2011"},{"key":"b2","series-title":"N Engl J Med","first-page":"1399","article-title":"Indicators of life-threatening malaria in African children","volume":"332","author":"Marsh","year":"1995"},{"key":"b3","series-title":"Ann Trop Paediatr","first-page":"355","article-title":"Predictors of mortality in Gambian children with severe malaria anemia","volume":"17","author":"Bojang","year":"1997"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"23","article-title":"In-hospital 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