Discharge policies and care practices for children with suspected sepsis: A health facility scan at a nationally representative sample of hospitals and health centres in Uganda

Under-five children in low- and middle-income countries remain at high risk of death after hospital discharge. However, few studies have systematically assessed discharge processes or facility readiness to support safe transitions of care. This study aimed to assess health facility readiness to provide pediatric discharge care for children under five years of age and current discharge practices in a nationally representative sample of health facilities in Uganda. A cross-sectional health facility scan was conducted between October 2020 and May 2021 at 36 facilities providing inpatient pediatric care in Uganda. Primary outcomes included: (1) facility readiness for pediatric discharge, defined as availability of infrastructure, technology, forms/job aids, and equipment; and (2) observed discharge care practices, including caregiver counselling, provision of take-home materials, post-discharge risk assessment, referrals, and clinical assessments on the day of discharge. Secondary outcomes included discrepancies between reported versus observed discharge care practices, discharge relevant admission practices, as well as caregiver and health worker satisfaction. Thiry-six health facilities were enrolled and 180 pediatric discharge observations, 180 caregivers, and 180 health workers were assessed. Hospitals had higher readiness scores in infrastructure (p < 0.001), technology (p = 0.006), and equipment (p = 0.021) than health centres. Hospitals also performed better in the provision of discharge risk assessment, clinical assessment on the day of discharge, follow-up, and provision of take-home materials. In contrast, health centres more consistently provided discharge counselling (p = 0.021) and had higher counselling topic scores (p < 0.001). Overall, 82.8% of discharges included a clinical assessment, 31.1% included a follow-up referral, and 26.1% included a risk assessment. Observed practices often diverged from reported procedures. These findings identified several priority areas for quality improvement in both resource availability and discharge care delivery in all settings. Standardizing discharge policies and tools may strengthen discharge care and may be used as a guide to inform national-level pediatric discharge policies.