Factors associated with length of hospital stay among sickle cell disease patients at Nalufenya and Mulago National Referral Hospitals: A cohort study.

Abstract

Introduction: Children with Sickle Cell Disease (SCD) suffer multiple and often prolonged hospitalizations. Increased length of hospital stay for these children has negative psychological, economic and health effects on the children, care takers and the health system as a whole. On the other hand, reduced hospital stay is associated with benefits like reduced mortality rates and lower financial stress. With the public hospitals in Uganda being congested, it is important to understand factors pertaining to the length of hospital stay among children with SCD. This study will therefore aim to estimate the length of hospital stay and its associated factors among children with sickle cell disease at both Nalufenya and Mulago National referral Hospitals (MNRH). Results from this study will enable stake holders to devise interventions to reduce hospital stay and subsequently reduce congestion of the hospitals, as well as to ensure well-being of the patients. Methods: A prospective cohort study was conducted among 385 children with SCD who were admitted at Nalufenya Hospital and MNRH between 15th December 2022 and 15th April 2023. Data collection was by interviewer administered questionnaires, review of hospital records and physical examination. The Kaplan−Meier method and log-rank test were used to estimate the cumulative probability of hospital discharge by each categorical variable. The Cox proportional-hazards regression model with robust standard errors and clustered by health facility was applied to determine the potential risk factors associated with length of hospital stay Results: Of the 385 study participants, 53.8% were male, while 46.2% were female. The mean age was 6.9 (±3.8) years while the median was 7.0 (4.0, 10.0) years. The mean length of hospital stay among children with SCD at Nalufenya Hospital and MNRH was 6.3 (±4.3) days, the median LOS was 5 (5 - 6) days. Children with secondary complications had the highest average LOS days of 11.5 (± 10.1) followed by children with severe malnutrition 10.3 (± 7.7). At multivariable analysis, a good nutritional status was associated with a shorter length of hospital stay (AHR 2.43, [95% CI: 1.86 – 3.18]), while factors less likely to be associated with a shorter length of hospital stay included acute chest syndrome (AHR 0.49, [95% CI: 0.43 – 0.57]), presence of secondary complications (AHR 0.35, [95% CI: 0.18 – 0.68]) and the child’s caretaker being a biological parent (AHR 0.74 [95% CI: 0.58 – 0.95]). Conclusions: The average LOS among children with sickle cell disease admitted at Nalufenya Hospital and MNRH is 6.3 (± 4.3) days. The factors associated with length of hospital stay among children with sickle cell disease at Nalufenya and Mulago National Referral Hospitals include; nutrition status, the type of crisis, co – infection, and care taker’s relationship with the patient. Recommendations: Streamlined care plans need to be made for children admitted with sickle cell disease to cater for improvement in nutrition status, pain management, and management of existing infections among the patients.