Article Category:
Research Article

Development and Internal Validation of a Risk Assessment Tool to Identify Neonates at Risk for 60-Day Hospital Readmission in Dar es Salaam, Tanzania, and Monrovia, Liberia

Rodrick R. Kisenge Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;

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Evance Godfrey Department of Pediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania;

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Readon C. Ideh Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia;

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Julia Kamara Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia;

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Ye-Jeung Coleman-Nekar Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia;

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Abraham Samma Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;

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Hussein K. Manji Accident and Emergency Department, Aga Khan Health Services, Dar es Salaam, Tanzania;
Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;

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Christopher R. Sudfeld Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;

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Adrianna Westbrook Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia;

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Michelle Niescierenko Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts;
Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts;

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Claudia R. Morris Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia;
Department of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia;

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Cynthia G. Whitney Emory Global Health Institute, Emory University, Atlanta, Georgia;

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Robert F. Breiman Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;
Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa;

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Christopher P. Duggan Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts

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Karim P. Manji Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;

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Chris A. Rees Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia;
Department of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia;

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DOI:
https://doi.org/10.4269/ajtmh.24-0648
Volume/Issue:
Ahead of Print
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Hospital readmissions among neonates are common and may reflect ongoing illness. We conducted a prospective observational cohort study of neonates discharged from two hospitals, one in Dar es Salaam, Tanzania, and one in Monrovia, Liberia, to develop and internally validate a risk assessment tool to identify neonates at risk for unplanned readmission within 60 days of discharge. One hundred and fifteen candidate variables were collected. The outcome of unplanned readmission was identified through phone calls to caregivers. We constructed a multivariable logistic regression model with best subset selection to identify the optimal combination of variables to identify neonates at risk for readmission. We used bootstrap validation with 500 repetitions to internally validate the tool. Of the 2,344 neonates discharged, 98.5% were enrolled and had 60-day outcomes. Of these, 3.6% were readmitted within 60 days of discharge, with 41.7% of readmissions occurring within 14 days of discharge. The risk assessment tool included eight variables that were predictive of readmissions. Neonates who had documented abnormal posturing during hospital admission (adjusted odds ratio [aOR] 7.29, 95% CI 1.51–35.12), hydrocephalus (aOR 7.52, 95% CI 1.21–46.95), and low birth weight (aOR 3.16, 95% CI 1.69–5.92) had the greatest risk of readmission. The overall discriminatory value of the risk assessment tool was 0.77 (95% CI 0.76–0.79). The risk assessment tool demonstrated excellent calibration for predicting readmissions at low scores. However, this tool requires external validation before it can be used in sub-Saharan Africa to direct resources for follow-up of high-risk neonates.

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Author Notes

Financial support: This study was funded by the NIH (K24 DK104676 and P30 DK040561 to C. P. Duggan, K24 AT009893 to C. R. Morris, and K23HL173694 to C. A. Rees), the Boston Children’s Hospital Global Health Program to C. A. Rees, the Palfrey Fund for Child Health Advocacy to C. A. Rees, and the Emory Pediatric Research Alliance Junior Faculty Focused Award to C. A. Rees. The funders had no role in the study design or in the collection, analysis, or interpretation of the data. The funders did not write the report and had no role in the decision to submit the paper for publication.

Disclosures: Before enrollment, we obtained ethical clearance from the ethical review boards of the following institutions: Tanzania National Institute of Medical Research, the Muhimbili University of Health and Allied Sciences, the JFKMC, and Boston Children’s Hospital. The institutional review board of Emory University provided approval for use of deidentified data in this study.

Current contact information: Rodrick R. Kisenge, Abraham Samma, and Karim P. Manji, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, E-mails: saroriki@yahoo.com, abesamma@gmail.com, and kpmanji@gmail.com. Evance Godfrey, Department of Pediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania, E-mail: gevance5@gmail.com. Readon C. Ideh, Julia Kamara, and Ye-Jeung Coleman-Nekar, Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia, E-mails: rideh1010@gmail.com, juliawisner1@gmail.com, and yejeungnekar@gmail.com. Hussein K. Manji, Accident and Emergency Department, Aga Khan Health Services, Dar es Salaam, Tanzania, and Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, E-mail: husseinsport2@hotmail.com. Christopher R. Sudfeld and Christopher P. Duggan, Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, E-mails: csudfeld@hsph.harvard.edu and christopher.duggan@childrens.harvard.edu. Adrianna Westbrook, Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, E-mail: adrianna.lynn.westbrook@emory.edu. Michelle Niescierenko, Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, and Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, E-mail: michelle.niescierenko@childrens.harvard. Claudia R. Morris, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, and Department of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, E-mail: claudia.r.morris@emory.edu. Cynthia G. Whitney, Emory Global Health Institute, Emory University, Atlanta, GA, E-mail: cwhitne@emory.edu. Robert F. Breiman, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, and Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa, E-mail: rfbreiman@emory.edu. Chris A. Rees, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, and Department of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, E-mail: chris.rees@emory.edu.

Address correspondence to Rodrick R. Kisenge, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O. Box, 65001 Dar es Salaam, Tanzania. E-mail: saroriki@yahoo.com
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
26 Sep 2024
|
Accepted:
28 Dec 2024
|
Published Online:
01 Apr 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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