{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T21:32:15Z","timestamp":1775079135247,"version":"3.50.1"},"reference-count":90,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"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":[[2026,4,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Post-discharge mortality (PDM), defined as deaths that occur in the weeks and months after hospital discharge, remains a critical, yet under-recognized, contributor to high childhood mortality rates in sub-Saharan Africa. However, a comprehensive understanding of effective interventions to prevent PDM is lacking. The aim for the present study was to evaluate the efficacy of published interventions to prevent PDM among neonates and children aged 0\u201318 years in sub-Saharan Africa. A systematic review was conducted to assess the efficacy of interventions for preventing PDM. The CABI Global Health, Cochrane Reviews, Cochrane Trials, ProQuest Dissertations and Theses, Embase, PubMed, and Web of Science databases were searched without language restriction. Publications that involved interventions for preventing PDM, included children, and were conducted in sub-Saharan Africa were included in the present study. Of 4,893 publications screened, 17 were included, with 12,938 participants in total (10.6% experienced PDM). The most common interventions included supplemental feeding programs, kangaroo mother care, antibiotic use, and micronutrient supplementation. Effectiveness varied within and between intervention types. Only two interventions resulted in statistically significant reductions in PDM: vitamin A supplementation for children with pneumonia (hazard ratio: 0.51; 95% CI: 0.29\u20130.90; low quality of evidence) and linkage to services for children with sickle cell disease (adjusted hazard ratio: 0.26; 95% CI: 0.08\u20130.83; low quality of evidence). No single intervention type provided consistent benefits across studies. Most interventions targeted children with specific diagnoses; however, some strategies addressed social determinants of health. Future research must prioritize cost-effective, scalable strategies across diverse sub-Saharan African settings to accelerate the prevention of PDM among children.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0567","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:00:18Z","timestamp":1771351218000},"page":"787-795","source":"Crossref","is-referenced-by-count":0,"title":["Interventions to Prevent Post-Discharge Mortality among Children in Sub-Saharan Africa: A Systematic Review"],"prefix":"10.4269","volume":"114","author":[{"given":"Kaitlin","family":"Cole","sequence":"first","affiliation":[{"name":"Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramya","family":"Ginjupalli","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim P.","family":"Manji","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrick","family":"Kisenge","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrianna","family":"Westbrook","sequence":"additional","affiliation":[{"name":"Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quique","family":"Bassat","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona, Spain;"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"ICREA, Barcelona, Spain;"},{"name":"Institut Cl\u00ednic de Medicina I Dermatologia, Hospital Cl\u00ednic de Barcelona, Barcelona, Spain;"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, Barcelona, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosauro","family":"Varo","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"CIBER de Epidemiolog\u00eda y Salud P\u00fablica, Instituto de Salud Carlos III, Madrid, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lola","family":"Madrid","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"},{"name":"College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inacio","family":"Mandomando","sequence":"additional","affiliation":[{"name":"ISGlobal, Barcelona, Spain;"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a, Maputo, Mozambique;"},{"name":"Instituto Nacional de Sa\u00fade, Minist\u00e9rio de Sa\u00fade, Maputo, Mozambique;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia R.","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia;"},{"name":"Children\u2019s Healthcare of Atlanta, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Rogers","sequence":"additional","affiliation":[{"name":"Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nega","family":"Assefa","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"},{"name":"College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Omore","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Akelo","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, Liverpool, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kitiezo Aggrey","family":"Igunza","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Duggan","sequence":"additional","affiliation":[{"name":"Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;"},{"name":"Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris A.","family":"Rees","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia;"},{"name":"Children\u2019s Healthcare of Atlanta, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"The Lancet","first-page":"1160","article-title":"Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950\u20132019: A comprehensive demographic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2019"},{"key":"b2","series-title":"Lancet","first-page":"430","article-title":"Global, regional, and national causes of child mortality in 2000\u201313, with projections to inform post-2015 priorities: An updated systematic analysis","volume":"385","author":"Liu","year":"2015"},{"key":"b3","series-title":"J Health Econ","first-page":"16","article-title":"Why has under-5 mortality decreased at such different rates in different countries?","volume":"48","author":"Jamison","year":"2016"},{"key":"b4","article-title":"Under-Five Mortality."},{"key":"b5","series-title":"JAMA Pediatr","first-page":"213","article-title":"Smart hospital discharges to address a neglected epidemic in sepsis in low- and middle-income countries","volume":"172","author":"Wiens","year":"2018"},{"key":"b6","series-title":"EClinicalMedicine","first-page":"102380","article-title":"Pediatric post-discharge mortality in resource-poor countries: A systematic review and meta-analysis","volume":"67","author":"Knappett","year":"2023"},{"key":"b7","series-title":"BMJ Open","first-page":"e023445","article-title":"Paediatric postdischarge mortality in developing countries: A systematic review","volume":"8","author":"Nemetchek","year":"2018"},{"key":"b8","series-title":"Lancet Child Adolesc Health","first-page":"149","article-title":"Tackling post-discharge mortality in children living in LMICs to reduce child deaths","volume":"7","author":"Akech","year":"2023"},{"key":"b9","series-title":"PLoS One","first-page":"e66698","article-title":"Pediatric post-discharge mortality in resource poor countries: A systematic review","volume":"8","author":"Wiens","year":"2013"},{"key":"b10","series-title":"BMJ","first-page":"n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021"},{"key":"b11","article-title":"Systematic Review of Risk Assessment Tools and Interventions for Post-Discharge Mortality Among Children in Sub-Saharan Africa.","author":"Rees","year":"2024"},{"key":"b12","article-title":"World Bank Country and Lending Groups.","year":"2026"},{"key":"b13","series-title":"Lancet Glob Health","first-page":"e33","article-title":"Post-discharge malaria chemoprevention in children admitted with severe anaemia in malaria-endemic settings in Africa: A systematic review and individual patient data meta-analysis of randomised controlled trials","volume":"12","author":"Phiri","year":"2024"},{"key":"b14","series-title":"N Engl J Med","first-page":"2242","article-title":"Malaria chemoprevention in the postdischarge management of severe anemia","volume":"383","author":"Kwambai","year":"2020"},{"key":"b15","series-title":"Lancet Infect Dis","first-page":"191","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"},{"key":"b16","series-title":"PLoS One","first-page":"e11227","article-title":"Prevention of the recurrence of anaemia in Gambian children following discharge from hospital","volume":"5","author":"Bojang","year":"2010"},{"key":"b17","series-title":"BMJ","first-page":"l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019"},{"key":"b18","series-title":"J Clin Epidemiol","first-page":"383","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011"},{"key":"b19","series-title":"JAMA Netw Open","first-page":"e2315077","article-title":"Analysis of postdischarge interventions for children treated for moderate or severe wasting, growth faltering or failure, or edema: A systematic review","volume":"6","author":"Bliznashka","year":"2023"},{"key":"b20","series-title":"BMJ","first-page":"c1101","article-title":"Vitamin A supplementation and BCG vaccination at birth in low birthweight neonates: Two by two factorial randomised controlled trial","volume":"340","author":"Benn","year":"2010"},{"key":"b21","series-title":"EClinicalMedicine","first-page":"102640","article-title":"Nutritional supplementation in children with severe pneumonia in Uganda and Kenya (COAST-Nutrition): A phase 2 randomised controlled trial","volume":"72","author":"Kiguli","year":"2024"},{"key":"b22","series-title":"Acta Paediatr","first-page":"62","article-title":"The effect of nutritional support on weight gain of HIV-infected children with prolonged diarrhoea","volume":"96","author":"Rollins","year":"2007"},{"key":"b23","series-title":"Br J Nutr","first-page":"372","article-title":"Legume-supplemented feed for children hospitalised with severe malnutrition: A phase II trial","volume":"132","author":"Walsh","year":"2024"},{"key":"b24","series-title":"Lancet","first-page":"136","article-title":"Probiotics and prebiotics for severe acute malnutrition (PRONUT study): A double-blind efficacy randomised controlled trial in Malawi","volume":"374","author":"Kerac","year":"2009"},{"key":"b25","series-title":"EClinicalMedicine","first-page":"101050","article-title":"Impact of early kangaroo mother care versus standard care on survival of mild-moderately unstable neonates <2000 grams: A randomised controlled trial","volume":"39","author":"Brotherton","year":"2021"},{"key":"b26","series-title":"Ann Trop Paediatr","first-page":"55","article-title":"Long-term outcome of preterm infants discharged home on kangaroo care in a developing country","volume":"23","author":"Kambarami","year":"2003"},{"key":"b27","series-title":"Acta Pediatr","first-page":"e241","article-title":"Long-term effects of earlier initiated continuous Kangaroo Mother Care (KMC) for low-birth weight (LBW) infants in Madagascar","volume":"100","author":"Nagai","year":"2011"},{"key":"b28","series-title":"Lancet Glob Health","first-page":"e464","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"},{"key":"b29","series-title":"Lancet Glob Health","first-page":"e1569","article-title":"Azithromycin for the prevention of rehospitalisation and death among Kenyan children being discharged from hospital: A double-blind, placebo-controlled, randomised controlled trial","volume":"9","author":"Pavlinac","year":"2021"},{"key":"b30","series-title":"Lancet Glob Health","first-page":"e1435","article-title":"Co-trimoxazole or multivitamin multimineral supplement for post-discharge outcomes after severe anaemia in African children: A randomised controlled trial","volume":"7","author":"Maitland","year":"2019"},{"key":"b31","series-title":"Pediatr Infect Dis J","first-page":"127","article-title":"A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania","volume":"18","author":"Fawzi","year":"1999"},{"key":"b32","series-title":"J Trop Pediatr","first-page":"340","article-title":"A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. I: Mortality and morbidity","volume":"49","author":"Makonnen","year":"2003"},{"key":"b33","series-title":"J Infect Dis","first-page":"245","article-title":"Randomized trial of BCG vaccination at birth to low-birth-weight children: Beneficial nonspecific effects in the neonatal period?","volume":"204","author":"Aaby","year":"2011"},{"key":"b34","series-title":"J Pediatr","first-page":"290","article-title":"Linkage to care intervention to improve post-hospital outcomes among children with sickle cell disease in Tanzania: A pilot study","volume":"232","author":"Hau","year":"2021"},{"key":"b35","series-title":"Lancet HIV","first-page":"e12","article-title":"Urgent versus post-stabilisation antiretroviral treatment in hospitalised HIV-infected children in Kenya (PUSH): A randomised controlled trial","volume":"5","author":"Njuguna","year":"2018"},{"key":"b36","series-title":"Glob Health Sci Pract","first-page":"422","article-title":"Scheduled follow-up referrals and simple prevention kits including counseling to improve post-discharge outcomes among children in Uganda: A proof-of-concept study","volume":"4","author":"Wiens","year":"2016"},{"key":"b37","series-title":"Ann Glob Health","first-page":"73","article-title":"Improving child survival in sub-Saharan Africa: Key environmental and nutritional interventions","volume":"86","author":"Kofi Amega","year":"2020"},{"key":"b38","series-title":"J Pediatr","first-page":"114147","article-title":"Derivation and internal validation of a novel risk assessment tool to identify infants and young children at risk for post-discharge mortality in Dar es Salaam, Tanzania and Monrovia, Liberia","volume":"273","author":"Rees","year":"2024"},{"key":"b39","series-title":"Pediatrics","first-page":"e20180606","article-title":"Postdischarge mortality prediction in sub-Saharan Africa","volume":"143","author":"Madrid","year":"2019"},{"key":"b40","series-title":"BMJ Glob Health","first-page":"e017262","article-title":"Contribution of malnutrition to infant and child deaths in sub-Saharan Africa and South Asia","volume":"9","author":"Madewell","year":"2024"},{"key":"b41","series-title":"Afr Health Sci","first-page":"498","article-title":"A multi-year analysis of kangaroo mother care outcomes in low birth weight babies at a nyakahanga hospital in rural Tanzania","volume":"20","author":"Winkler","year":"2020"},{"key":"b42","series-title":"Pediatrics","first-page":"e2023062011","article-title":"Verbal autopsy to assess postdischarge mortality in children with suspected sepsis in Uganda","volume":"152","author":"Knappett","year":"2023"},{"key":"b43","series-title":"Food Nutr Bull","first-page":"348","article-title":"Vitamin A deficiency and child survival in sub-Saharan Africa: A reappraisal of challenges and opportunities","volume":"26","author":"Aguayo","year":"2005"},{"key":"b44","series-title":"Am J Clin Nutr","first-page":"854","article-title":"Vitamin A deficiency has declined in Malawi, but with evidence of elevated vitamin A in children","volume":"113","author":"Williams","year":"2021"},{"key":"b45","series-title":"Lancet Glob Health","first-page":"e1306","article-title":"Seeking interventions to reduce post-discharge mortality among children in sub-Saharan Africa","volume":"7","author":"Prendergast","year":"2019"},{"key":"b1","series-title":"The Lancet","first-page":"1160","article-title":"Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950\u20132019: A comprehensive demographic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2019"},{"key":"b2","series-title":"Lancet","first-page":"430","article-title":"Global, regional, and national causes of child mortality in 2000\u201313, with projections to inform post-2015 priorities: An updated systematic analysis","volume":"385","author":"Liu","year":"2015"},{"key":"b3","series-title":"J Health Econ","first-page":"16","article-title":"Why has under-5 mortality decreased at such different rates in different countries?","volume":"48","author":"Jamison","year":"2016"},{"key":"b4","article-title":"Under-Five Mortality."},{"key":"b5","series-title":"JAMA Pediatr","first-page":"213","article-title":"Smart hospital discharges to address a neglected epidemic in sepsis in low- and middle-income countries","volume":"172","author":"Wiens","year":"2018"},{"key":"b6","series-title":"EClinicalMedicine","first-page":"102380","article-title":"Pediatric post-discharge mortality in resource-poor countries: A systematic review and meta-analysis","volume":"67","author":"Knappett","year":"2023"},{"key":"b7","series-title":"BMJ Open","first-page":"e023445","article-title":"Paediatric postdischarge mortality in developing countries: A systematic review","volume":"8","author":"Nemetchek","year":"2018"},{"key":"b8","series-title":"Lancet Child Adolesc Health","first-page":"149","article-title":"Tackling post-discharge mortality in children living in LMICs to reduce child deaths","volume":"7","author":"Akech","year":"2023"},{"key":"b9","series-title":"PLoS One","first-page":"e66698","article-title":"Pediatric post-discharge mortality in resource poor countries: A systematic review","volume":"8","author":"Wiens","year":"2013"},{"key":"b10","series-title":"BMJ","first-page":"n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021"},{"key":"b11","article-title":"Systematic Review of Risk Assessment Tools and Interventions for Post-Discharge Mortality Among Children in Sub-Saharan Africa.","author":"Rees","year":"2024"},{"key":"b12","article-title":"World Bank Country and Lending Groups.","year":"2026"},{"key":"b13","series-title":"Lancet Glob Health","first-page":"e33","article-title":"Post-discharge malaria chemoprevention in children admitted with severe anaemia in malaria-endemic settings in Africa: A systematic review and individual patient data meta-analysis of randomised controlled trials","volume":"12","author":"Phiri","year":"2024"},{"key":"b14","series-title":"N Engl J Med","first-page":"2242","article-title":"Malaria chemoprevention in the postdischarge management of severe anemia","volume":"383","author":"Kwambai","year":"2020"},{"key":"b15","series-title":"Lancet Infect Dis","first-page":"191","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"},{"key":"b16","series-title":"PLoS One","first-page":"e11227","article-title":"Prevention of the recurrence of anaemia in Gambian children following discharge from 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