Promoting post discharge survival

Dr. Matthew Wiens

In many countries throughout Africa five to ten percent of children admitted to the hospital with an infectious illness will die during their hospital stay. However, an even higher percentage die in the weeks after discharge. Dr. Matthew Wiens, a PhD candidate in the School of Population and Public Health, seeks to help those doctors and parents who are often unaware of this vulnerability period and ill-equipped to quickly identify and treat recurrent illness. He recently received a Grand Challenges Canada grant for his Uganda-based Post Discharge Survival Project. Dr Wiens spoke about the project:

What was the impetus for this project?
My PhD research has focused the generally unrecognized issue of pediatric post-discharge morbidity and mortality in resource poor settings. I moved to Mbarara, Uganda in 2011 to initiate a cohort study of children who have been discharged following an admission for infectious illness. We enrolled nearly 1,500 subjects and found that the post-discharge mortality rate is actually higher than the in-hospital mortality rate. I have now returned to Canada, and I am beginning to explore solutions to the situation that, unfortunately, claims more lives than the acute phase of hospitalization.

How will you identify the children who are the most vulnerable?
This new project builds upon our current research. We are using our main cohort study on post-discharge mortality to build a prediction model that can be applied towards a post-discharge intervention. We have not yet finished creating a post-discharge prediction model; this will be occurring over the next few months. Still, preliminary analyses have already identified some important variables that predict post-discharge re-admission and mortality, such as age, admission temperature (particularity hypothermia) and oxygen saturation.

What is the project’s plan?
Our plan is to develop and implement a post-discharge bundle that consists of a discharge survival kit (primarily an educational intervention for caregivers), a back-referral to existing community health workers and a prediction tool (on a mobile phone platform). We hope that this strategy can improve early health seeking and in turn reduce morbidity and mortality.

How are you creating the mobile phone prediction tool?
Once the prediction model has been developed we will work in close collaboration with the Electrical and Computer Engineering in Medicine team at UBC to create the app. ECEM has extensive experience in the creation of mobile applications for use in a clinical context. The use of a mobile application will play a major role in identifying those children who require more intensive post-discharge care. In a resource limited context like Uganda the allocation of scarce resources is of utmost importance and for this the app will play a crucial role.

When will this project be in place?
Over the next 3-6 months we will be working to develop the prediction model and integrate this with a mobile application. Following this, we will begin an 8-10 month cohort study in Mbarara Uganda where we will implement our post-discharge bundle and measure post-discharge outcomes.

Dr. Wiens would like to acknowledge Grand Challenges Canada, which is funded by the government of Canada and supports bold ideas with big impact. His bold project will have a big impact on the lives of many Ugandan families.

All photos: Micah Dekorne of Designed4 Humanitarian Media