Death in a diarrhoeal cohort of infants and young children soon after discharge from hospital: risk factors and causes by verbal autopsy.

Assessing mortality pattern of children after discharge from hospital is important to guide appropriate management policy. We studied young children aged 1-23 months, who were discharged from an urban Diarrhoea Treatment Hospital. Children were enrolled on discharge from the hospital, and followed at home after 6 and 12 weeks to assess post-discharge mortality. Of 500 children, 427 were available for evaluation at home 6 weeks after discharge. The median age of the children was eight months, 77 per cent of whom were less than 12 months of age. Of the 427 children, 30 (7 per cent) died within 6 weeks and two died within 12 weeks of discharge from hospital. The median survival time of the deceased was 11 days. Children less than 6 months of age had a five times greater risk of death compared with those aged 6 months or older. Malnutrition, non-breastfeeding, and lack of immunization were important risk factors for death. As ascertained by verbal autopsy, the underlying causes of death were respiratory diseases and watery diarrhoea. Malnutrition and low birth weight were the main associated causes. Hospitalized children, especially young infants, should be given special attention and need to be followed preferably within a week of discharge.