Open AccessVery severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study
Author(s) -
Neema Chami,
Duncan K. Hau,
Tulla Masoza,
Luke R. Smart,
Neema Kayange,
Adolfine Hokororo,
Emmanuela E. Ambrose,
Peter P. Moschovis,
Matthew O. Wiens,
Robert Peck
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0214563
Subject(s) - medicine , anemia , pediatrics , hazard ratio , prospective cohort study , mortality rate , cohort study , proportional hazards model , cohort , confidence interval
Background Africa has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia. Objective To determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia. Methods We conducted a prospective cohort study enrolling children 2–12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis. Results Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53–3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00–1.03) and decreased urine output (HR 4.30, 95% Cl 1.04–17.7). Conclusions Children up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children.