Post-discharge mortality in children with severe malnutrition and pneumonia in Bangladesh

PLoS One. 2014 Sep 16;9(9):e107663. doi: 10.1371/journal.pone.0107663. eCollection 2014.


Background: Post-discharge mortality among children with severe illness in resource-limited settings is under-recognized and there are limited data. We evaluated post-discharge mortality in a recently reported cohort of children with severe malnutrition and pneumonia, and identified characteristics associated with an increased risk of death.

Methods: Young children (<5 years of age) with severe malnutrition (WHO criteria) and radiographic pneumonia on admission to Dhaka Hospital of icddr,b over a 15-month period were managed according to standard protocols. Those discharged were followed-up and survival status at 12 weeks post-discharge was determined. Verbal autopsy was requested from families of those that died.

Results: Of 405 children hospitalized with severe malnutrition and pneumonia, 369 (median age, 10 months) were discharged alive with a follow-up plan. Of these, 32 (8.7%) died in the community within 3 months of discharge: median 22 (IQR 9-35) days from discharge to death. Most deaths were reportedly associated with acute onset of new respiratory or gastrointestinal symptoms. Those that died following discharge were significantly younger (median 6 [IQR 3,12] months) and more severely malnourished, on admission and on discharge, than those that survived. Bivariate analysis found that severe wasting on admission (OR 3.64, 95% CI 1.66-7.97) and age <12 months (OR 2.54, 95% CI 1.1-8.8) were significantly associated with post-discharge death. Of those that died in the community, none had attended a scheduled follow-up and care-seeking from a traditional healer was more common (p<0.001) compared to those who survived.

Conclusion and significance: Post-discharge mortality was common in Bangladeshi children following inpatient care for severe malnutrition and pneumonia. The underlying contributing factors require a better understanding to inform the potential of interventions that could improve survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bangladesh / epidemiology
  • Child Nutrition Disorders / complications*
  • Child Nutrition Disorders / epidemiology
  • Child Nutrition Disorders / mortality*
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Patient Discharge*
  • Pneumonia / complications*
  • Pneumonia / epidemiology
  • Pneumonia / mortality*
  • Severity of Illness Index

Grants and funding

This research study was funded by the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B; grant no Gr-00233) and its donors, which provide unrestricted support to ICDDR, B for its operations and research. Current donors providing unrestricted support include: Australian Agency for International Development, Government of the People’s Republic of Bangladesh, Canadian International Development Agency, Swedish International Development Cooperation Agency, and the Department for International Development, United Kingdom. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.