Potential impact on under 5 mortality of improving either district hospital inpatient fatality rates or the success of referral to hospital or both, measured at the community level
| Assumptions | Effect size used to estimate reduction in under 5 mortality. |
|---|---|
| Notes | |
| 1. There are likely to be major differences in the degree to which disease specific case fatality rates can be reduced, thus a hospital’s case-mix will be a considerable influence on the potential for reducing overall inpatient mortality. | |
| 2. It is possible that children not currently referred differ from those easily referred—perhaps they are sicker (referral is not deemed worthwhile), or are in the terminal stages of chronic illness, or live much further away with the prospect that they will arrive in hospital with less chance of being saved. | |
| 3. An increase in the number of referrals may overload an already busy hospital, resulting in a lower quality of care and a lower than expected impact. | |
| Improving impatient fatality | |
| 1 | 30% of all under 5 deaths occur in hospital but IP fatality is reduced to 90% of baseline |
| 2 | 30% of all under 5 deaths occur in hospital but IP fatality is reduced to 80% of baseline |
| 3 | 30% of all under 5 deaths occur in hospital but IP fatality is reduced to 70% of baseline |
| 4 | 30% of all under 5 deaths occur in hospital but IP fatality is reduced to 60% of baseline |
| Improving referral to hospital of children currently dying in the community | |
| 1 | 10% of the 70% of children previously dying outside hospital are instead successfully referred. IP fatality in this new group is very conservatively estimated to be as high as 30% (see note 2 below) |
| 2 | 20% of the 70% of children previously dying outside hospital are instead successfully referred. IP fatality as above is very conservatively estimated at 30% in this new group |
| 3 | 30% of the 70% of children previously dying outside hospital are instead successfully referred. IP fatality as above is very conservatively estimated at 30% in this new group |
| 4 | 40% of the 70% of children previously dying outside hospital are instead successfully referred. IP fatality as above is very conservatively estimated at 30% in this new group |
| Improving both IP fatality and referral | |
| 2 | Combined effect of both assumptions for IP fatality and referral labelled 2 |
| 3 | Combined effect of both assumptions for IP fatality and referral labelled 3 |
| 4 | Combined effect of both assumptions for IP fatality and referral labelled 4 |