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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data
BMC Public Health, Volume 21, No. 1, Article 1480, Year 2021
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Description
Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. © 2021, The Author(s).
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC8323322/bin/12889_2021_11481_MOESM1_ESM.docx
Authors & Co-Authors
Connon, Roisin
United Kingdom, London
University College London
George, Elizabeth C.
United Kingdom, London
University College London
Olopot-Olupot, Peter Simon
Uganda, Mbale
Mbale Clinical Research Institute
Uganda, Tororo
Busitema University
Kiguli, Sarah
Uganda, Kampala
Makerere University
Chagaluka, George
Malawi, Blantyre
Kamuzu University of Health Sciences
Alaroker, Florence Olwedo Egwau
Uganda, Soroti
Soroti Regional Referral Hospital
Opoka, Robert Opika
Uganda, Kampala
Makerere University
Mpoya, Ayub
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Walsh, Kevin J.
United Kingdom, London
Imperial College London
Engoru, Charles
Uganda, Soroti
Soroti Regional Referral Hospital
Nteziyaremye, Julius
Uganda, Mbale
Mbale Clinical Research Institute
Uganda, Tororo
Busitema University
Mallewa, MacPherson
Malawi, Blantyre
Kamuzu University of Health Sciences
Kennedy, Neil
Malawi, Blantyre
Kamuzu University of Health Sciences
United Kingdom, Belfast
Queen's University Belfast
Nakuya, Margaret
Uganda, Soroti
Soroti Regional Referral Hospital
Namayanja, Cate
Uganda, Mbale
Mbale Clinical Research Institute
Uganda, Tororo
Busitema University
Nabawanuka, Eva
Uganda, Kampala
Makerere University
Sennyondo, Tonny
Uganda, Mbale
Mbale Clinical Research Institute
Uganda, Tororo
Busitema University
Amorut, Denis
Uganda, Soroti
Soroti Regional Referral Hospital
Williams Musika, C.
Uganda, Kampala
Makerere University
Bates, Imelda
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Boele van Hensbroek, Michael
Netherlands, Amsterdam
Emma Kinderziekenhuis
Evans, Jennifer A.
United Kingdom, Cardiff
University Hospital of Wales
Uyoga, Sophie M.
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Williams, Thomas Neil
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
United Kingdom, London
Imperial College London
Frost, Gary Steven
United Kingdom, London
Imperial College London
Gibb, Diana M.
United Kingdom, London
University College London
Maitland, Kathryn M.
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
United Kingdom, London
Imperial College London
Walker, Anne Sarah
United Kingdom, London
University College London
Kayaga, Julianne
Unknown Affiliation
Kadama, Eva
Unknown Affiliation
Mbwali, Immaculate
Unknown Affiliation
Nuwabaine, Lilian
Unknown Affiliation
Nakikwaku, R.
Unknown Affiliation
Nsubuga, Julius
Unknown Affiliation
Mpande, K.
Unknown Affiliation
Adoo, R.
Unknown Affiliation
Ouma, Ogol Japheth
Unknown Affiliation
Adia, Neil K.
Unknown Affiliation
Namanyanga, C.
Unknown Affiliation
Passi, George
Unknown Affiliation
Adong, Ruth
Unknown Affiliation
Okalebo, Charles Benard
Unknown Affiliation
Atimango, Emmanuela
Unknown Affiliation
Mwamula, S.
Unknown Affiliation
Kapsindet, Job
Unknown Affiliation
Muhindo, G. Kiluli R.
Unknown Affiliation
Thembo, G. Masifa N.
Unknown Affiliation
Odong, George W.
Unknown Affiliation
Aloroker, Florence
Unknown Affiliation
Ariima, M.
Unknown Affiliation
Itipe, Melda
Unknown Affiliation
Atim, Mary Gorret
Unknown Affiliation
Abeno, Mary
Unknown Affiliation
Amede, B.
Unknown Affiliation
Olupot, Moses
Unknown Affiliation
Okwi, Steven
Unknown Affiliation
Kulume, Mary G.
Unknown Affiliation
Among, Grace
Unknown Affiliation
Onyas, Pius
Unknown Affiliation
Achipa, E. D.
Unknown Affiliation
Maitland, Kathryn
Unknown Affiliation
Maitha, P.
Unknown Affiliation
Uyoga, S.
Unknown Affiliation
MacHaria, Alex W.
Unknown Affiliation
Chimalizeni, Yamikani Fg
Unknown Affiliation
Kumwenda, Felistas
Unknown Affiliation
Nkosi, Elizabeth
Unknown Affiliation
Sochera, Tiferanji Fatch
Unknown Affiliation
Malenga, Albert
Unknown Affiliation
Gushu, Benard
Unknown Affiliation
Phiri, Tusekile
Unknown Affiliation
Chisale, A.
Unknown Affiliation
Mitole, Ndaona
Unknown Affiliation
Chokani, Ellida
Unknown Affiliation
Munthali, Annie
Unknown Affiliation
Maitland, Katherine
Unknown Affiliation
Frost, G.
Unknown Affiliation
Walsheto, K.
Unknown Affiliation
Gibb, Di M.
Unknown Affiliation
Thomason, Margaret J.
Unknown Affiliation
Baptiste, David
Unknown Affiliation
McCabe, Leanne
Unknown Affiliation
Walker, Ann Sarah
Unknown Affiliation
Ali, Abdul
Unknown Affiliation
Khamis, Kibibi
Unknown Affiliation
Madula, M.
Unknown Affiliation
Abongo, Grace
Unknown Affiliation
Heydermann, Robert
Unknown Affiliation
Urban, Britta Christina
Unknown Affiliation
Kyomuhendo, Flavia
Unknown Affiliation
Nakalanzi, Sarah
Unknown Affiliation
Chabuka, John
Unknown Affiliation
Mkandawire, Nkhafwire
Unknown Affiliation
Gibb, D. M.
Unknown Affiliation
Fitzgerald, Felicity C.
Unknown Affiliation
Molyneux, Elizabeth M.
Unknown Affiliation
Kazembe, Peter Nicholas
Unknown Affiliation
Crawley, Jane C.
Unknown Affiliation
Peto, Timothy E.A.
Unknown Affiliation
Musoke, Philippa Martha
Unknown Affiliation
Todd, Jim E.
Unknown Affiliation
Mirembe, Grace
Unknown Affiliation
Tenu, Filemoni F.
Unknown Affiliation
Statistics
Citations: 9
Authors: 103
Affiliations: 12
Identifiers
Doi:
10.1186/s12889-021-11481-6
ISSN:
14712458
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Malawi
Uganda