Post-discharge mortality in suspected pediatric sepsis: Insights from rural and urban healthcare settings in Rwanda.

Summary

In 1,218 Rwandan children admitted with suspected infection, overall mortality was 9.4% with half occurring post-discharge (4.7%). Post-discharge mortality was highest in infants 0–6 months (10%) and higher in the urban hospital. Risk factors included severe malnutrition (aOR 3.31) and low maternal education in infants, and abnormal Blantyre score, >1-hour travel time, and referral for higher care in older children.

Key Findings

• Overall mortality 9.4% (in-hospital 4.7%; post-discharge 4.7%); median time to post-discharge death ~33–38 days.
• Post-discharge mortality highest in 0–6 months (10%) and higher in the urban hospital (Kigali 10.3% vs. Ruhengeri 2.7%).
• Infants: severe malnutrition increased post-discharge death risk (aOR 3.31), higher maternal education was protective (aOR 0.15).
• Children 6–60 months: abnormal Blantyre Coma Scale (aOR 3.28), travel time >1 hour (aOR 3.54), and referral for higher care (aOR 4.13) predicted death.

Clinical Implications

Implement structured post-discharge follow-up within 2–6 weeks, caregiver counseling, nutritional support, and community health worker monitoring, prioritizing high-risk infants.

Limitations

• Conducted at two hospitals in Rwanda, which may limit generalizability
• Inclusion based on suspected/confirmed infection may introduce heterogeneity in sepsis definitions

Future Directions

Test scalable post-discharge care bundles and mobile health follow-up, and evaluate cost-effectiveness and equity impacts across LMIC settings.