Pediatric Infectious Disease in Resource-Limited Settings: Describing Post-Discharge Mortality in Uganda

Abstract

Background and Objectives Pediatric post-discharge mortality in low-resources settings is a topic only starting to be understood. However, it has been largely demonstrated that children are dying after hospitalization, and in rates yet to be fully realized. Using Critical Social Theory as a framework, objectives included: to determine the current evidence addressing pediatric post-discharge mortality in resource-poor settings; determine potential predictor variables for infant post-discharge mortality at the time of initial hospital admission; and to establish the state of knowledge of social justice in global health within the nursing profession and provide clarity and understanding to the concept.

Methods A manuscript-style approach was used, wherein each manuscript addresses an individual objective. This is achieved using a systematic literature review, modified two-stage Delphi process, and concept analysis. Results Rates of post-discharge mortality continue to be comparable to or exceed in-hospital mortality, with most post-discharge deaths occurring at home. Risk factors consistently highly associated with post-discharge mortality underlay the vulnerability associated with factors regardless of underlying infectious etiology. Predictor variables for post-discharge mortality among infants brought objectivity and insight to aspects of predictive value, reliability, availability, and applicability in low-resource settings. The identified variables are a valuable starting point for the construction of a predictive model to identify at-risk infants. A greater understanding of social justice, in particular within a global health context for the nursing profession, is developed for nursing to move to a more global practice as agents of social change. Significance Children continue to die unnecessarily and in staggering, under-recognized numbers, particularly in countries where strained and resource-limited health systems attempt to assist millions of socioeconomically disadvantaged children. Addressing these issues, identifying the most vulnerable children, and developing effective interventions is essential for achieving the Sustainable Development Goals outlined by the United Nations. Every day nurses as key members of health care teams around the world play a critical role in the health and wellbeing of patients, families, communities, and nations. Nursing has a vital role to play in not only addressing childhood post-discharge mortality, but in global health in its entirety. It must be a concerted effort on all parts, from health care teams to policy makers, community leaders, researchers, and funders.