Smart discharges to improve post-discharge health outcomes in children: A prospective before-after study with staggered implementation

Children hospitalized for serious infections in Africa have a very high post-discharge mortality rate. This means that many children who seem healthy after an infection return to their homes and then get sick again and die. In places like Uganda, as many children die during the weeks after they are discharged from a hospital as die during hospitalization. The data shows this is about 5% in each case. Most of these deaths occur at home. This has been shown in several studies throughout Africa.

Serious infections can include pneumonia, diarrhea or malaria. The danger is when infections lead to sepsis. Sepsis is a life-threatening condition where the body’s response to an infection damages its own tissues and organs. Instead of local inflammation resulting from a local infection, which would be the appropriate response, the body’s entire system goes into inflammation. Sepsis is the leading cause of death from infection around the world, despite advances in modern medicine like vaccines, antibiotics and acute care. Newborn babies, small children and the elderly are especially vulnerable.

We use a simple mobile app powered by scientifically rigorous, data-driven prediction models to identify vulnerable children at admission. All children and their families recieve educational counselling on post-discharge care whereas children who are vulnerable to post-discharge mortality and morbidity also recieve follow-up visits either at their local health centre or by a community health worker. All facility-based and community-based health workers are trained using the Smart Discharges Health Worker Training Program, enabling them to provide high quality peri-discharge care. This is an effective way to save lives.