High Postdischarge Morbidity in Ugandan Children With Severe Malarial Anemia or Cerebral Malaria
Robert O Opoka1, Karen E S Hamre2, Nathan Brand3
1Departments of Paediatrics.
Insights
Children with severe malarial anemia (SMA) face higher hospitalization risks post-discharge. Both SMA and cerebral malaria (CM) patients experience increased illness, with malaria being the primary cause, highlighting the need for malaria prophylaxis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Cerebral malaria (CM) and severe malarial anemia (SMA) are leading causes of pediatric malaria deaths in sub-Saharan Africa.
- Post-discharge morbidity in children surviving CM or SMA is not well-documented.
Purpose of the Study:
- To investigate the incidence of hospitalizations and outpatient clinic visits in children following discharge for CM or SMA.
- To compare post-discharge morbidity between children with CM/SMA and healthy community controls.
Main Methods:
- A 6-month follow-up study was conducted in Kampala, Uganda.
- Children aged 18 months to 12 years admitted with CM (n=162) or SMA (n=138) were compared to healthy community children (n=133).
- Incidences of hospitalizations and clinic visits for illness were recorded and analyzed.
Main Results:
- Children with SMA showed significantly higher rates of hospitalization (IRR 20.81) and clinic visits for any illness (IRR 2.35) compared to controls.
- Children with CM also had increased clinic visits for illness (IRR 2.24), though other measures did not reach statistical significance.
- Malaria was the predominant cause for both hospitalizations and clinic visits in the CM and SMA groups.
Conclusions:
- Children with SMA have a substantially increased risk of re-hospitalization within six months.
- Both CM and SMA survivors face elevated risks of outpatient illness, primarily due to malaria.
- Malaria prophylaxis could significantly reduce post-discharge morbidity in these vulnerable children.
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.
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