By Elizabeth Kaudha
About the author
Elizabeth Kaudha is a paediatrician, an early career researcher and PhD fellow on the SUPPORT project. My research project focuses on the role of serum biomarkers in predicting post discharge mortality (PDM) and readmission among children living with HIV (CLHIV). Serum biomarkers are substances that are measured in blood to show how well the body is functioning in relation to a specific disease or treatment.
Introduction
For many families, the date a child is discharged from hospital is a day of jubilation. It marks the end of sleepless nights, anxiety and worry over the child’s recovery. It brings thoughts of relief, of going back to the comfort of home and a battle won. Health care workers also celebrate another life saved as they discharge the child with instructions on how to care for and give the discharge medications. This however, is the beginning of a vulnerable period which has largely gone unrecognized for long, especially among CLHIV. During this vulnerable period, children are at risk of death-post discharge mortality and readmission to hospital.
PDM, readmission and the use of serum biomarkers
PDM and readmission to hospital suggest that recovery from the illness that caused the initial hospital admission and discharge doesn’t mean complete recovery and long-term survival. Disturbances in normal body function, poor nutrition, side effects of medications, may contribute to a state in which the child is vulnerable to getting worse even after recovery from the illness that caused hospitalization. Barriers to returning to hospital such as transportation costs, costs to buy prescribed medicine, care costs, limited access to health care services, health care seeking behavior, caregivers’ inability to recognize persistent or worsening symptoms, may contribute to PDM. For CLHIV, these challenges are made worse by delayed diagnosis, adverse events from antiretroviral treatment, interruption of treatment and presence of other infections.
PDM and readmission are most common in the first 6 months following hospital discharge. In most health care systems, especially in Low- and Middle-Income Countries, discharge means the end of structured care, and the child is often taken as fully recovered. Full recovery should mean that a child survives the illness that caused the hospitalization but also continues to grow and thrive to achieve their full potential in life. This requires health care systems to improve the discharge planning and follow up to identify children at highest risk of PDM and readmission and develop individualized care plans. The use of serum biomarkers may provide a practical approach to identify these children, especially among CLHIV who are one of the most vulnerable, and facilitate targeted follow up, optimize resource allocation, support clinical decision making and contribute to reducing PDM and readmission and ultimately to reducing child deaths.
Looking Ahead
Every child deserves more than survival to hospital discharge, especially CLHIV, who are one of the most vulnerable groups. They deserve a chance to fully recover, thrive and grow. Health care systems, researchers, policy makers, and communities all have roles to play to ensure that no child is forgotten once they have been discharged. Going home is not the end of illness, but the beginning of the next critical period for child survival and the use of serum biomarkers to identify those at most risk, might provide the answer so that these can be followed up appropriately.
