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ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Children and Health
Volume 12 - 2024 |
doi: 10.3389/fped.2024.1374629
Identifying and Quantifying Initial Post-Discharge Needs for Clinical Review of Sick, Newborns in Kenya based on a large multi-site, retrospective cohort study
Provisionally accepted- 1 Health Services Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- 2 Department of Pediatrics, Rush Medical College, Rush University, Chicago, Illinois, United States
- 3 Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- 4 Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, England, United Kingdom
Progress in neonatal care has resulted in a 51% decrease in global neonatal mortality rates from 1990 to 2017. Enhanced survival will put pressure on health care systems to provide appropriate post-discharge, follow-up care but the scale of need for such care is poorly defined.We conducted a retrospective cohort study of newborns discharged from 23 public hospital neonatal units (NBUs) in Kenya between January 2018 and June 2023 to identify initial follow-up needs. We first determined pragmatic follow-up categories based on survivors' clinical conditions and morbidities. We then used individual phenotypes of individual babies to assign them to needing one or more forms of specialized clinical follow-up. We use descriptive statistics to estimate proportions of those with specific needs and patterns of need.Among 136,249/159,792 (85.3%) neonates discharged, around one-third (33%) were low birth weight (<2500g), and a similar 33.4% were preterm (<37 weeks). We estimated 131,351 initial episodes of follow-up would be needed across nine distinct follow-up categories: general pediatrics, nutrition, growth & development (40.4%), auditory screening (38.8%), ophthalmology for retinopathy of prematurity (9.6%), neurology (8.0%), occupational therapy (1.3%), specialized nutrition (0.9%), surgery (0.8%), cardiology (0.2%), and pulmonary (<0.1%). Most neonates met the criteria for two (52.3%, 28,733), followed by three (39.6%, 21,738) and one follow-up episodes (5.6%, 3,098). In addition to prematurity and very low birth weight (≤1500g), severe infections with extended gentamicin treatment, severe jaundice managed with phototherapy, and hypoxic-ischemic encephalopathy (HIE) contributed substantially to the pattern of need for post-discharge follow-up.Almost half of surviving NBU infants have multiple specialty post-discharge follow-up needs. More urgent attention needs to be focused on healthcare planning now to guide strategies to address the varied medical and developmental needs that we outline in resource-constrained contexts like Kenya.
Keywords: Newborn, Infant, post-discharge, Specialist, follow-up, Morbidity, complications
Received: 22 Jan 2024; Accepted: 30 Aug 2024.
Copyright: © 2024 Mwangi, Lee, Irimu, Aluvaala and English. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
John W. Mwangi, Health Services Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
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