Risk factors and causes of death in young children after discharge from an urban diarrhoea treatment centre
Objective: Assess mortality patterns, causes of death, and risk factors in infants and young children discharged from a diarrhoea treatment centre. Methods: Five hundred children aged 1 to 24 months were followed up at home 6 and 12 weeks after discharge from the ICDDR.B's urban diarrhoea treatment centre in Dhaka, Bangladesh. The main outcome measure in this cohort was death. The causes of death were ascertained by a verbal autopsy. Results: The homes of 427 (85%) children could be located 6 weeks after discharge; the rest had changed addresses and could not be traced. Of the children whose homes were located, 61% were boys; 77% were of less than 1 year; and 61% had siblings present. The median (range) of family members present was 5 (2-13). The median (range) monthly family income was Tk 3,000 or US$ 75.00 (Tk 600-30,000). Of the 427 children, 30 (7%) had died within 6 weeks of discharge; 2 more children died between 6 and 12 weeks of discharge. Of the children who died, the mean survival time after discharge was 10.9 days. Age, malnutrition, and lack of immunization were the main risk factors associated with death. The main underlying causes of death were respiratory diseases and watery diarrhoea. Malnutrition was the main associated cause. Conclusions: Hospitalized children, especially malnourished infants, should be advised to return for a follow-up visit within a week of discharge. Hospitals should also provide preventive measures like immunizations, nutrition education, and dietary management in diarrhoea.