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. 2017 Sep 1;6(3):e41-e48.
doi: 10.1093/jpids/piw060.

High Postdischarge Morbidity in Ugandan Children With Severe Malarial Anemia or Cerebral Malaria

Robert O Opoka  1 , Karen E S Hamre  2 , Nathan Brand  3 , Paul Bangirana  4 , Richard Idro  1 , Chandy C John  2   5
Affiliations

High Postdischarge Morbidity in Ugandan Children With Severe Malarial Anemia or Cerebral Malaria

Robert O Opoka et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Cerebral malaria (CM) and severe malarial anemia (SMA) account for a substantial proportion of malaria-related deaths in sub-Saharan Africa. However, postdischarge morbidity in children with CM or SMA has not been well established.

Methods: Children 18 months to 12 years of age, enrolled on admission to Mulago National Referral Hospital in Kampala, Uganda (CM, n = 162; SMA, n = 138), and healthy children recruited from the community (CC) (n = 133) were followed up for 6 months. The incidences of hospitalizations and outpatient clinic visits for illness during the follow-up period were compared between children with CM or SMA and the CC.

Results: After adjustment for age, sex, and nutritional status, children with SMA had a higher incidence rate ratio (IRR) than CC for hospitalization (95% confidence interval [CI], 20.81 [2.48-174.68]), hospitalization with malaria (17.29 [95% CI, 2.02-148.35]), and clinic visits for any illness (95% CI, 2.35 [1.22-4.51]). Adjusted IRRs for children with CM were also increased for all measures compared with those for CC, but they achieved statistical significance only for clinic visits for any illness (2.24 [95% CI, 1.20-4.15]). In both groups, the primary reason for the clinic visits and hospitalizations was malaria.

Conclusions: In the 6 months after initial hospitalization, children with SMA have an increased risk of repeated hospitalization, and children with CM or SMA have an increased risk of outpatient illness. Malaria is the main cause of inpatient and outpatient morbidity. Malaria prophylaxis has the potential to decrease postdischarge morbidity rates in children with SMA or CM.

Keywords: cerebral malaria; incidence; readmission; severe malarial anemia.

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Figures

Figure 1.
Figure 1.
Study enrollment and follow-up.
Figure 2.
Figure 2.
Time to hospitalization for any illness in community children (CC), children with cerebral malaria (CM), and children with severe malarial anemia (SMA).
Figure 3.
Figure 3.
Time to hospitalization for malaria in community children (CC), children with cerebral malaria (CM), and children with severe malarial anemia (SMA).
Figure 4.
Figure 4.
Time to clinic visit for any illness in community children (CC), children with cerebral malaria (CM), and children with severe malarial anemia (SMA).
Figure 5.
Figure 5.
Time to clinic visit for malaria in community children (CC), children with cerebral malaria (CM), and children with severe malarial anemia (SMA).
See this image and copyright information in PMC

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