In 2019, nearly 750,000 children under the age of 5 died due to pneumonia worldwide. Many of these deaths are in sub-Saharan Africa, including Uganda. In these countries, children hospitalized for severe infections such as pneumonia are as likely to die after discharge as they are to die while in hospital. World Pneumonia Day, held annually on November 12, aims to promote prevention, treatment, and to encourage policymakers to do more in the fight against the largest infectious killer of children globally. Programs that support improved transitions in care for children or pneumonia are a key part of this fight.
For the past decade, the Smart Discharges program, led by Dr. Matthew Wiens at the Institute for Global Health at BC Children's Hospital and BC Women's Hospital + Health Centre and Dr. Nathan Kenya-Mugisha at WALIMU, a Ugandan NGO, have been developing predictive models to assess a child's risk of mortality after being discharged from health facilities following treatment for a severe infection, including pneumonia. Simple prevention programs, including education and post-discharge referrals, have shown positive results in improving health-seeking behavior and reducing post-discharge death.
A new and ongoing prospective observational cohort study is set to enroll 1,000 children under the age of 13 at three health facilities in Northern Uganda. The study aims to examine post-discharge mortality among vulnerable refugee children, primarily originating from South Sudan, to assess the suitability of the Smart Discharges' risk stratification model. Uganda hosts nearly 1.5 million refugees and asylum seekers, including 255,000 children under 5 years of age. Yet, there is a stark absence of epidemiological data regarding post-discharge mortality and morbidity within this specific population. By refining and enhancing the existing prediction models for children in refugee settings, the Smart Discharges program aims to ensure that high-quality, evidence-based care is accessible to all children in Uganda, including those from refugee backgrounds.
"The ability to identify children at risk of poor post-discharge outcomes is of paramount importance, especially within the vulnerable refugee settings where this project is focused," says Dr. Wiens. "This critical information enables us to allocate our limited resources towards improving the hospital-to-community transition in the most efficient way possible. Such programs not only save lives and resources but are much more likely to be scalable in economically strained environments."
To date, the Smart Discharges studies have enrolled over 12,000 children under the age of 5 with suspected sepsis and have demonstrated the effectiveness of an evidence-based risk-prediction tool in reducing post-discharge mortality. The ongoing research aims to expand and validate Smart Discharges as a scalable solution, without bias, for improving post-discharge outcomes among all pediatric populations.
