@article {Wiens422, author = {Matthew O Wiens and Elias Kumbakumba and Charles P Larson and Peter P Moschovis and Celestine Barigye and Jerome Kabakyenga and Andrew Ndamira and Lacey English and Niranjan Kissoon and Guohai Zhou and J Mark Ansermino}, title = {Scheduled Follow-Up Referrals and Simple Prevention Kits Including Counseling to Improve Post-Discharge Outcomes Among Children in Uganda: A Proof-of-Concept Study}, volume = {4}, number = {3}, pages = {422--434}, year = {2016}, doi = {10.9745/GHSP-D-16-00069}, publisher = {Global Health: Science and Practice}, abstract = {Post-hospital discharge is a vulnerable time for recurrent illness and death among children. An intervention package consisting of (1) referrals for scheduled follow-up visits, (2) discharge counseling, and (3) simple prevention items such as soap and oral rehydration salts resulted in much higher health seeking and hospital readmissions compared with historical controls.Background: Recurrent illness following hospital discharge is a major contributor to childhood mortality in resource-poor countries. Yet post-discharge care is largely ignored by health care workers and policy makers due to a lack of resources to identify children with recurrent illness and a lack of cohesive systems to provide care. The purpose of this proof-of-concept study was to evaluate the effectiveness of a bundle of interventions at discharge to improve health outcomes during the vulnerable post-discharge period.Methods: The study was conducted between December 2014 and April 2015. Eligible children were between ages 6 months and 5 years who were admitted with a suspected or proven infectious disease to one of two hospitals in Mbarara, Uganda. A bundle of interventions was provided at the time of discharge. This bundle included post-discharge referrals for follow-up visits and a discharge kit. The post-discharge referral was to ensure follow-up with a nearby health care provider on days 2, 7, and 14 following discharge. The discharge kit included brief educational counseling along with simple preventive items as incentives (soap, a mosquito net, and oral rehydration salts) to reinforce the education. The primary study outcome was the number of post-discharge referral visits completed. Secondary study outcomes included satisfaction with the intervention, rates of readmission after 60 days, and post-discharge mortality rates. In addition, outcomes were compared with a historical control group, enrolled using the same inclusion criteria and outcome-ascertainment methods.Results: During the study, 216 children were admitted, of whom 14 died during hospitalization. Of the 202 children discharged, 85\% completed at least 1 of the 3 follow-up referral visits, with 48\% completing all 3 visits. Within 60 days after discharge, 22 children were readmitted at least once and 5 children (2.5\%) died. Twelve (43\%) readmissions occurred during a scheduled follow-up visit. Compared with prospectively enrolled historical controls, the post-discharge referral for follow-up increased the odds of readmission (odds ratio [OR], 1.92; 95\% confidence interval [CI], 1.14 to 3.23) and care sought after discharge (OR, 14.61; 95\% CI, 9.41 to 22.67). Overall satisfaction with the bundle of interventions was high, with most caregivers strongly agreeing that the discharge kit and post-discharge referrals improved their ability to care for their child.Conclusions: Interventions initiated at the time of discharge have the potential to profoundly affect the landscape of care during illness recovery and lead to significantly improved outcomes among children under 5 years of age.}, URL = {https://www.ghspjournal.org/content/4/3/422}, eprint = {https://www.ghspjournal.org/content/4/3/422.full.pdf}, journal = {Global Health: Science and Practice} }