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. 2017 Nov;97(5):1513-1523.
doi: 10.4269/ajtmh.17-0056. Epub 2017 Oct 10.

Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case-Control Study

Arthur Mpimbaza  1 , Grace Ndeezi  2 , Anne Katahoire  1 , Philip J Rosenthal  3 , Charles Karamagi  4   2
Affiliations

Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case-Control Study

Arthur Mpimbaza et al. Am J Trop Med Hyg. 2017 Nov.

Abstract

We studied associations between delayed care seeking, demographic, socioeconomic, and geographic factors and likelihood of severe malaria in Ugandan children. The study was based at Jinja Hospital, Uganda. We enrolled 325 severe malaria cases and 325 uncomplicated malaria controls matched by age and residence. Patient details, an itinerary of events in response to illness, household information, and location of participants' residences were captured. Conditional logistic regression was used to determine risk factors for severe malaria and delayed care seeking. Delayed care seeking (≥ 24 hours after fever onset; odds ratio [OR] 5.50; 95% confidence interval [CI] 2.70, 11.1), seeking care at a drug shop as the initial response to illness (OR 3.62; 95% CI 1.86, 7.03), and increasing distance from place of residence to the nearest health center (OR 1.45; 95% CI 1.17, 1.79) were independent risk factors for severe malaria. On subgroup analysis, delayed care seeking was a significant risk factor in children with severe malaria attributable to severe anemia (OR 15.6; 95% CI 3.02, 80.6), but not unconsciousness (OR 1.13; 95% CI 0.30, 4.28). Seeking care at a drug shop (OR 2.84; 95% CI 1.12, 7.21) and increasing distance to the nearest health center (OR 1.18; 95% CI 1.01, 1.37) were independent risk factors for delayed care seeking. Delayed care seeking and seeking care at a drug shop were risk factors for severe malaria. Seeking care at a drug shop was also a predictor of delayed care seeking. The role of drug shops in contributing to delayed care and risk of severe malaria requires further study.

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Figures

Figure 1.
Figure 1.
Study site. Map demonstrating locations of residence’s for both severe malaria cases and uncomplicated malaria cases within the catchment area of Jinja Hospital. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Study profile.
Figure 3.
Figure 3.
Venn diagram: Distribution of the three principal severe malaria syndromes among the cases. This figure appears in color at www.ajtmh.org.
See this image and copyright information in PMC

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