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Competing risk survival analysis of time to in-hospital death or discharge in a large urban neonatal unit in Kenya

机译：肯尼亚大型城市新生儿院内死亡或出院时间的竞争风险生存分析

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>Background: Clinical outcomes data are a crucial component of efforts to improve health systems globally. Strengthening of these health systems is essential if the Sustainable Development Goals (SDG) are to be achieved. Target 3.2 of SDG Goal 3 is to end preventable deaths and reduce neonatal mortality to 12 per 1,000 or lower by 2030. There is a paucity of data on neonatal in-hospital mortality in Kenya that is poorly captured in the existing health information system. Better measurement of neonatal mortality in facilities may help promote improvements in the quality of health care that will be important to achieving SDG 3 in countries such as Kenya. >Methods: This was a cohort study using routinely collected data from a large urban neonatal unit in Nairobi, Kenya. All the patients admitted to the unit between April 2014 to December 2015 were included. Clinical characteristics are summarised descriptively, while the competing risk method was used to estimate the probability of in-hospital mortality considering discharge alive as the competing risk. >Results: A total of 9,115 patients were included. Most were males (966/9115, 55%) and the majority (6287/9115, 69%) had normal birthweight (2.5 to 4 kg). Median length of stay was 2 days (range, 0 to 98 days) while crude mortality was 9.2% (839/9115). The probability of in-hospital death was higher than discharge alive for birthweight less than 1.5 kg with the transition to higher probability of discharge alive observed after the first week in birthweight 1.5 to <2 kg. >Conclusions: These prognostic data may inform decision making, e.g. in the organisation of neonatal in-patient service delivery to improve the quality of care. More of such data are therefore required from neonatal units in Kenya and other low resources settings especially as more advanced neonatal care is scaled up.
机译：>背景：临床结果数据是全球改善卫生系统的重要组成部分。如果要实现可持续发展目标（SDG），则必须加强这些卫生系统。可持续发展目标目标3的目标3.2是到2030年结束可预防的死亡并将新生儿死亡率降低至每千人中12人或更低。肯尼亚的新生儿院内死亡率数据很少，现有的卫生信息系统所收集的数据很少。在设施中更好地衡量新生儿死亡率可能有助于促进医疗保健质量的提高，这对于在肯尼亚等国家实现SDG 3至关重要。 >方法：这是一项队列研究，使用的是从肯尼亚内罗毕的一个大型城市新生儿院定期收集的数据。纳入2014年4月至2015年12月期间入院的所有患者。描述性地总结了临床特征，同时使用竞争风险法以活着出院作为竞争风险来估计院内死亡的可能性。 >结果：总共纳入了9,115例患者。大多数是男性（966/9115，占55％），大多数（6287 / 9115，69％）具有正常的出生体重（2.5至4千克）。中位住院时间为2天（范围为0至98天），而粗死亡率为9.2％（839/9115）。出生体重不足1.5 kg的院内死亡的可能性高于活产，而出生体重1.5到<2 kg的第一周后观察到活产的可能性更高。 >结论：这些预测数据可能会为决策提供依据，例如在组织新生儿住院服务时要提高护理质量。因此，在肯尼亚和其他资源贫乏地区，尤其是随着更高级的新生儿护理规模的扩大，需要更多此类数据。

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