Table 1.
Child characteristics at index admission and discharge.
| All participants (N = 2874) | No readmission (N = 2368) | At least one readmission (N = 506) | P-value | |
|---|---|---|---|---|
| Demographics | ||||
| Cohort strata | ||||
| Not wasted (NW) | 1072 (37) | 899 (38) | 173 (34) | 0.23 |
| Moderately wasted (MW) | 724 (25) | 595 (25) | 129 (26) | |
| Severely wasted/kwashiorkor (SKW) | 1078 (38) | 874 (37) | 204 (40) | |
| Age — months median (IQR) | 10.8 (6.8–15.6) | 11.0 (7.0–15.8) | 10.3 (6.2–14.8) | 0.01 |
| Sex — no. (%) | ||||
| Male | 1635 (57) | 1327 (56) | 308 (61) | 0.05 |
| Female | 1239 (43) | 1041 (44) | 198 (39) | |
| Recruiting site | ||||
| Kilifi County Hospital, Kenya | 227 (7.9) | 187 (7.9) | 40 (7.9) | <0.0001 |
| Mbagathi Hospital, Kenya | 254 (8.8) | 199 (8.4) | 55 (11) | |
| Migori County Hospital, Kenya | 233 (8.1) | 209 (8.8) | 24 (4.7) | |
| Mulago National Rereferral Hospital, Uganda | 446 (16) | 369 (16) | 77 (15) | |
| Queen Elizabeth Central Hospital, Malawi | 285 (9.9) | 220 (9.3) | 65 (13) | |
| Dhaka Hospital, Bangladesh | 385 (13) | 291 (12) | 94 (19) | |
| Matlab Hospital, Bangladesh | 311 (11 | 270 (11) | 41 (8.1) | |
| Karachi Civil Hospital, Pakistan | 337 (12) | 272 (11) | 65 (13) | |
| Banfora Regional Referral Hospital, Burkina Faso | 396 (14) | 351 (15) | 45 (8.9) | |
| Length of admission — days median (IQR) | 4 (2–7) | 4 (2–7) | 5 (3–8) | 0.02 |
| Discharge on a weekend — no. (%) | 572 (20) | 467 (20) | 105 (21) | 0.60 |
| Leaving against medical advice | 205 (7.1) | 177 (7.5) | 28 (5.5) | 0.12 |
| Change in anthropometry at hospital dischargea | ||||
| No change | 2447 (85) | 2014 (85) | 433 (86) | 0.02 |
| Improved | 354 (12) | 302 (13) | 52 (10) | |
| Worsened | 73 (2.5) | 52 (2.2) | 21 (4.2) | |
| Clinical presentation at admission | ||||
| SIRS — no. (%)b | 948 (33) | 747 (32) | 201 (40) | <0.0001 |
| Severe pneumonia — no. (%)c | 589 (20) | 462 (20) | 127 (25) | 0.005 |
| Diarrhoea — no. (%) | 1580 (55) | 1317 (56) | 263 (52) | 0.14 |
| Malaria (RDT positive) — no. (%) | 408 (14) | 350 (15) | 58 (11) | 0.008 |
| Anaemia — no. (%)d | ||||
| None | 558 (19) | 458 (19) | 100 (20) | 0.90 |
| Mild | 652 (23) | 532 (22) | 120 (24) | |
| Moderate | 1261 (44) | 1046 (44) | 215 (42) | |
| Severe | 403 (14) | 332 (14) | 71 (14) | |
| Blood glucose — no. (%)e | ||||
| Normal blood glucose | 2674 (93) | 2202 (93) | 472 (93) | 0.82 |
| Abnormal blood glucose | 200 (7.0) | 166 (7.0) | 34 (6.7) | |
| Acute illness at index discharge | ||||
| SIRS — no. (%)b | 415 (14) | 338 (14) | 77 (15) | 0.58 |
| Severe pneumonia — no. (%)c | 167 (5.8) | 140 (5.9) | 27 (5.3) | 0.62 |
| Anaemia — no. (%)d | ||||
| None | 357 (12) | 279 (12) | 78 (15) | 0.03 |
| Mild | 711 (25) | 607 (26) | 104 (21) | |
| Moderate | 1586 (55) | 1302 (55) | 284 (56) | |
| Severe | 220 (7.7) | 180 (7.6) | 40 (7.9) | |
| HIV status | ||||
| HIV status — no. (%) | ||||
| Negative | 2570 (89) | 2138 (90) | 432 (85) | 0.001 |
| HIV infected | 77 (2.7) | 45 (1.9) | 24 (4.7) | |
| HIV exposed | 158 (5.5) | 124 (5.2) | 34 (6.7) | |
| Refused/untested | 69 (2.4) | 61 (2.6) | 16 (3.2) | |
| Underlying conditions | ||||
| Stunting — no. (%)f | ||||
| None | 1469 (51) | 1239 (52) | 230 (45) | <0.0001 |
| Moderate | 665 (23) | 554 (23) | 111 (22) | |
| Severe | 740 (26) | 575 (24) | 165 (33) | |
| Small birth size — no. (%)g | 482 (17) | 387 (16) | 95 (19) | 0.18 |
| Chronic conditions — no. (%)h | 192 (6.7) | 130 (5.5) | 62 (12) | <0.0001 |
| Prior hospitalization — no. (%) | ||||
| No prior admission | 2140 (74) | 1821 (77) | 319 (63) | <0.0001 |
| Prior admission | 734 (26) | 547 (23) | 187 (37) | |
| Caregiver characteristics | ||||
| Biological mother is primary caregiver — no. (%) | 2743 (95) | 2263 (96) | 480 (95) | 0.49 |
| Mother currently sick — no. (%) | 426 (15) | 348 (15) | 78 (15) | 0.68 |
| Caregiver education — no. (%) | ||||
| None | 749 (26) | 624 (26) | 125 (25) | 0.16 |
| Primary | 1228 (43) | 1023 (43) | 205 (41) | |
| Secondary/Tertiary | 897 (31) | 721 (30) | 176 (35) | |
| Maternal mental health (PHQ9) score — no. (%) | ||||
| None to mild | 2338 (81) | 1957 (83) | 381 (75) | <0.0001 |
| Moderate to severe | 536 (19) | 411 (17) | 125 (25) | |
| Mother working — no. (%) | ||||
| Self-employed | 570 (20) | 469 (20) | 101 (20) | 0.29 |
| Employed | 282 (9.8) | 223 (9.4) | 59 (12) | |
| No reported income | 2022 (70) | 1676 (71) | 346 (68) | |
| Household-level exposures | ||||
| Assets index — no. (%) | ||||
| Quintile 1 (Least assets) | 541 (19) | 462 (20) | 79 (16) | 0.02 |
| Quintile 2 | 553 (19) | 471 (20) | 82 (16) | |
| Quintile 3 | 570 (20) | 469 (20) | 101 (20) | |
| Quintile 4 | 598 (21) | 476 (20) | 122 (24) | |
| Quintile 5 (Most assets) | 612 (21) | 490 (21) | 122 (24) | |
| Household food insecurity — no. (%) | ||||
| Low | 1745 (61) | 1465 (62) | 280 (55) | 0.004 |
| Medium | 776 (27) | 632 (27) | 144 (28) | |
| High | 353 (12) | 271 (11) | 82 (16) | |
| Access to health care | ||||
| Distance to study hospital (km) median (IQR) | 8.94 (4.40–19.7) | 9.28 (4.51–21.0) | 7.78 (4.06–14.5) | 0.002 |
| Distance to nearest health facility (km) median (IQR) | 1.26 (0.52–3.09) | 1.31 (0.55–3.24) | 1.05 (0.44–2.56) | 0.003 |
Data are N (%) or median (IQR), P-values are from chi-square or Wilcoxon Rank Sum tests.
Abbreviation: IQR, Interquartile range; SIRS, Systemic Inflammatory Response Syndrome; RDT, rapid diagnostic test.
Change in anthropometry was estimated using Mid-Upper Arm circumference (MUAC), improved means discharge MUAC was greater than admission MUAC, while worsen means the MUAC declined at discharge.
SIRS defined as presence of two of the following four criteria; heart rate low (<90) or high (>180)/min; temperature low (<36 °C) or high (≥38.5 °C); respiratory rate high (>34 breaths per minute) and WBC low (<5 × 109/l) or high (>17.5 × 109/l).
Severe pneumonia: Cough or difficulty in breathing with; oxygen saturation <90% or central cyanosis, or grunting, very severe chest indrawing, or inability to breastfeed or drink, lethargy or reduced level of consciousness, convulsions.
Anaemia by haemoglobin defined as None: >11, Mild: 10–11, Moderate: 7–10 and Severe: <7.0 g/dl.
Abnormal blood glucose defined as blood glucose <3 or 10 mmol/l.
Stunting: none, length-for-age z score ≥−2; moderate, length-for-age z score −2 to −3; severe, length-for-age z score <−3.
Small birth size was defined as reported low birth weight (<2.5 kg) or born premature.
Chronic conditions includes thalassemia, cerebral palsy, sickle cell disease, congenital cardiac disease and known TB.