Table 2.
Demographic and Clinical Factors Associated With In-hospital Mortality Among Infants Aged <1 Year, South Africa, July 2016–October 2018
| Variable | Categories | Total, No. N = 1321 |
No. of deaths N = 27 |
Mortality ratio, % (95% CI) |
P-valueg | Odds ratioh (95% Cl) |
P-value | Adjusted ORi (95% CI) | P-value |
|---|---|---|---|---|---|---|---|---|---|
| HIV status | HUU | 721 | 12 | 1.7 (0.9–2.9) | <.001 | Reference | Reference | ||
| HEU | 526 | 8 | 1.5 (0.7–2.3) | 0.99 (0.40–2.44) | 0.974 | 0.80 (0.31–2.09) | .652 | ||
| HI | 47 | 6 | 12.8 (4.7–27.8) | 7.39 (2.58–21.19) | <0.001 | 4.79 (1.49–15.37) | .008 | ||
| Unknown | 27 | 1 | 3.7 (0.1–19.0) | 2.06 (0.25–16.83) | 0.499 | 1.94 (0.21–17.91) | .557 | ||
| Site | Mpumalanga | 214 | 6 | 2.8 (1.0–6.1) | <.001 | N/A | |||
| KwaZulu-Natal | 682 | 4 | 0.6 (0.2–1.5) | N/A | |||||
| North West | 425 | 17 | 4.0 (2.3–6.41 | N/A | |||||
| Year | 2016 | 177 | 5 | 2.8 (0.9–6.6) | .667 | Reference | |||
| 2017 | 574 | 10 | 1.7 (0.8–3.2) | 0.68 (0.22–2.07) | 0.493 | ||||
| 2018 | 570 | 12 | 2.1 (1.1–3.7) | 0.81 (0.27–2.10) | 0.702 | ||||
| Sex | Male | 762 | 13 | 1.7 (0.9–2.9) | .311 | Reference | |||
| Female | 559 | 14 | 2.5 (1.3–3.9) | 1.47 (0.68–3.18) | 0.324 | ||||
| Race | Black African | 1301 | 27 | 2.1 (1.4–3.0) | .515 | Reference | |||
| Non-black African | 20 | 0 | 0.00 | ||||||
| Age group (months) | <1 | 108 | 3 | 2.8 (0.6–8.1) | .138 | 1.09 (0.28–4.29) | 0.897 | 0.49 (0.09–2.76) | .416 |
| 1 to <3 | 363 | 4 | 1.1 (0.3–2.8) | 0.24 (0.07–0.80) | 0.020 | 0.15 (0.04–0.63) | .010 | ||
| 3 to <6 | 335 | 8 | 2.4 (1.0–4.7) | 0.60 (0.23–1.60) | 0.307 | 0.51 (0.18–1.44) | .200 | ||
| 6 to <9 | 277 | 3 | 1.1 (0.2–3.2) | 0.26 (0.07–0.97) | 0.045 | 0.20 (0.05–0.82) | .025 | ||
| 9 to <12 | 238 | 9 | 3.8 (1.7–7.2) | Reference | Reference | ||||
| Underlying conditiona | No | 1282 | 25 | 1.95 (1.3–2.9) | .167 | Reference | |||
| Yes | 39 | 2 | 5.1 (0.6–18.5) | 5.48 (1.12–26.79) | 0.036 | ||||
| Malnutritionb | No | 975 | 9 | 0.92 (0.4–1.8) | <.001 | Reference | Reference | ||
| Yes | 345 | 18 | 5.2 (3.1–8.3) | 5.19 (2.29–11.79) | <0.001 | 4.80 (2.00–11.51) | <.001 | ||
| Unknown | 1 | 0 | 0.0 | ||||||
| Feeding type | Exclusive breastfeeding | 705 | 13 | 1.8 (1.0–3.2) | .946 | Reference | Reference | ||
| Mixed feeding | 240 | 5 | 2.1 (0.7–4.9) | 1.04 (0.36–2.95) | 0.948 | 1.02 (0.32–3.24) | .975 | ||
| Formula feeding | 333 | 8 | 2.4 (1.0–4.7) | 1.39 (0.57–3.40) | 0.475 | 1.27 (0.48–3.35) | .634 | ||
| Unknown | 43 | 1 | 2.3 (0.1–12.3) | 1.30 (0.16–10.34) | 0.802 | 0.57 (0.05–5.96) | .635 | ||
| Prematurityc | No | 1081 | 23 | 2.1 (1.4–3.2) | .648 | Reference | |||
| Yes | 240 | 4 | 1.7 (0.5–4.3) | 0.76 (0.26–2.25) | 0.618 | ||||
| Birthweightd | Normal | 970 | 21 | 2.2 (1.3–3.3) | .457 | Reference | |||
| Low | 280 | 6 | 2.1 (0.8–4.7) | 1.01 (0.40–2.54) | 0.986 | ||||
| Unknown | 71 | 0 | 0.0 | ||||||
| Vaccinatione | Full coverage | 962 | 16 | 1.7 (1.0–2.7) | .253 | 0.49 (0.21–1.13) | 0.095 | 0.20 (0.06–0.66) | 008 |
| No full coverage | 307 | 9 | 2.9 (1.3–5.6) | Reference | Reference | ||||
| Unknown | 52 | 2 | 3.9 (0.5–13.2) | 1.35 (0.28–6.54) | 0.713 | 0.62 (0.10–4.02) | .617 | ||
| Admission diagnosisf | Non-respiratory | 630 | 15 | 2.4 (1.3–3.9) | .663 | Reference | |||
| Respiratory | 682 | 12 | 1.76 (0.9–3.1) | 0.64 (0.30–1.40) | 0.264 | ||||
| Unknown | 9 | 0 | 0.0 | ||||||
| Mothers/caregivers education level | None/Primary | 616 | 18 | 2.9 (1.7–4.6) | .103 | Reference | Reference | ||
| Secondary/Tertiary | 692 | 9 | 1.3 (0.6–2.5) | 0.61 (0.26–1.41) | 0.244 | 0.77 (0.31–1.89) | .570 | ||
| Unknown | 13 | 0 | 0.0 |
Underlying condition includes any of the following: asthma, chronic lung, heart, liver or renal disease, stroke, sinusitis, organ transplant, anemia, immunosuppressive therapy, splenectomy, diabetes, burns immunoglobulin deficiency, autoimmune disease, nephrotic syndrome, cancer, spinal cord injury, seizure disorder, cerebral palsy, congenital heart disease, other congenital disorder, obesity, or chronic gastrointestinal problems.
Malnutrition defined as a weight-for-age <−2 standard deviations from the WHO mean Z-score.
Prematurity defined as gestational age at birth of <37 weeks.
Low infant birthweight defined as <2500 g.
Vaccination defined as full vaccine coverage for age, using the Haemophilus influenzae type b vaccine given as part of the routine infant immunization schedule at 6,10, 14 weeks as a proxy.
Admission diagnosis: respiratory diagnosis includes apnea, neonatal sepsis, bronchiolitis, pneumonia, tuberculosis, and bronchitis and non-respiratory diagnosis includes encephalitis, viral illness, diarrhea, febrile seizures, meningitis, sepsis (non-neonatal), and other diagnosis.
Chi-squared test P-value.
Univariate mixed effects regression model, accounting for clustering by site.
Multivariable mixed effects regression model, accounting for clustering by site.