Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda,...

Malaria remains a major global health burden, with 264 million cases and 569,000 deaths in 2023. Uganda ranks third globally in malaria cases and tenth in deaths, with 95% of the country endemic and children under five most vulnerable. Despite control efforts, Mbale Regional Referral Hospital (MRRH) in Eastern Uganda reported a pediatric malaria case fatality rate of 2.7% between 2020 and 2024. This study aimed to identify factors associated with malaria-related deaths among children under five admitted to the hospital during this period. We conducted an unmatched 1:2 case-control study using retrospective data from 2020-2024. Cases were children ≤59 months with WHO-defined severe Plasmodium falciparum malaria who died during hospitalization (n = 100). Controls were similar children who recovered (n = 200), systematically sampled from about 32,400 admissions. Data were extracted from patient records, and multivariable logistic regression identified mortality predictors. Among 100 cases, 73% were aged <24 months and 61% were male. Convulsions (adjusted odds ratio [aOR]=17; 95%CI:4.2-71), loss of consciousness (aOR=14; 95%CI: 1.4-113), severe anemia (aOR=3.4; 95%CI:1.4-8.2), vomiting (aOR=3.1; 95%CI: 1.4-6.9), and delays in seeking care > 24 hours after symptom onset (aOR=8.8; 95%CI: 2.3-34) were significantly associated with mortality.Malaria deaths among under-five children was significantly associated with severe clinical features,convulsions, loss of consciousness, and severe anemia and delayed care-seeking. Early recognition of danger signs, and prompt care-seeking could reduce paediatric malaria mortality in high-burden settings like Mbale.