Faculty of Health Sciences

Description of the clinical spectrum and outcomes of childhood severe malaria in eastern Uganda

Fri, 25 Nov 2022 00:00:00 GMT

Description of the clinical spectrum and outcomes of childhood severe malaria in eastern Uganda Namayanja, Cate Severe malaria remains a major public health problem in Sub-Saharan Africa (SSA).It has a wide spectrum of clinical and laboratory features. Commonly reported are; severe anaemia, respiratory distress, convulsions and impaired consciousness. A number of children experience a febrile illness following a severe malaria episode. However, there are no focused studies on determining the post therapeutic malaria parasitaemia in this area. The overarching aim of this study was to determine the clinical spectrum, posttherapeutic malaria parasitaemia and treatment outcomes of childhood severe malaria in Eastern Uganda. Methodology: I employed a prospective cohort study for 138 children with severe malaria. I studied a population of children aged from 60 days (2 months) to less than12 years admitted to Mbale Regional Referral Hospital (MRRH) with confirmed P.falciparum severe malaria. Follow up of 93 children was done after 28 days to determine post therapeutic malaria parasitaemia. A structured data collection tool was used to capture participant social demographics, current illness history, features of severe malaria, treatment and follow-up details. Laboratory studies included blood slide for malaria, CBC, lactate, glucose, i-STAT, urine dipstick, and biochemistry at day 0. Additional blood slides were carried out at discharge and at follow up to determine malaria parasitaemia at both time points. Data was analysed using STATA V15.0. The univariate, bivariate, and multivariate analyses were carried out. Results: I recruited 138 participants starting from 01/OCT/2021 to 01 /Mar/ 2022 and analysed data for 138 on the social demographics. I analysed complete data sets for 137, 93,115 and 99 children for severe malaria spectrum, post therapeutic parasitaemia, prolonged hospitalisation and mortality respectively. The overall median age was 4.0years, the eldest being 10.7 years and the youngest 2months. A big proportion 84/138 (60.9%) were under 5 years, 76/138 (55.1%) males. Many of the participants were from Budaka district with 41/138 (29.7%), Mbale 34/138 (24.6%) and the least were from Serere, Namisindwa, Manafwa, Kumi and Bugweri districts. A big proportion had prostration 109/137(79.6%), jaundice 84/137(61.3%), and severe malaria anaemia 75/137(54.7%). Post therapeutic malaria parasitaemia was found in 31/93 (33.3%) after day 28 of treatment. Prolonged hospitalisation was in 23/115(20%) and was highly associated with hypoxaemia OR 14.6 95% CI (2.6, 83.0) P=0.002, hyperlactaemia OR 5.3 95% CI (1.6, 17.2) P=0 .005, acidosis OR 6.1 95%CI (1.4, 25.0) P-value=0.002, impaired consciousness OR CI 4.4(1.5, 12.9) p=0.007. The overall mortality was 6/137(4.4%). Case fatality rate was high for severe anaemia. However, impaired consciousness OR 3.0 95% CI (1.1, 4.9) P=0.002, respiratory distress OR 16.1 95% CI (2.9, 89.3) P= 0.001, acidosis OR 13 95% CI (2.5, 172.3) P=0.002, cerebral malaria OR 8.9 95% CI (1.5, 52.5) iP= 0.015, hypoglycemia OR 16.8 95% CI (1.5, 189.4) P= 0.022 and renal impairment OR 9.9 95% CI (1.1, 90.0) P= 0.040. Conclusion: The findings affirm the changing trend in the severe malaria spectrum with increased prevalence in children above 5 years, more cases of prostration, jaundice, haemoglobinuria and less of shock. Post therapeutic parasitaemia in a sizeable proportion of 33.3% could suggest recrudescence, new infection or resistance and calls for further research confirming these possibilities. Prolonged hospitalisation was noted in smaller proportion in upto 20%. Overall mortality appears to have come down to 4.4% compared to a decade ago of 9.5%. This mortality though is still high. Recommendation: Frequent and regular epidemiological and clinical studies on severe and complicated malaria to inform improved case management and aid reduction in mortality. Keywords: severe malaria, children, post therapeutic parasitaemia, prolonged hospitalization, mortality

MALARIA PARASITE DENSITY AND PATIENT OUTCOMES AMONG CHILDREN ADMITTED WITH SEVERE MALARIA IN MBALE HOSPITAL; A CROSS SECTIONAL STUDY.

Wed, 23 Nov 2022 00:00:00 GMT

MALARIA PARASITE DENSITY AND PATIENT OUTCOMES AMONG CHILDREN ADMITTED WITH SEVERE MALARIA IN MBALE HOSPITAL; A CROSS SECTIONAL STUDY. Egiru, Emma Isalah Eregu Background: Paucity of data on the role of parasite density on clinical manifestations of severe malaria and their outcomes in children has been noted. This study aimed at ascertaining the role of parasite density in influencing the manifestations and outcomes of clinically severe malaria in children in Mbale, Eastern Uganda. Methods: A cross sectional study was conducted to determine the parasite density, clinical spectrum, and outcomes of severe Plasmodium falciparum malaria at Mbale Regional Referral Hospital, Eastern Uganda. Children aged 2 months to 12 years were recruited after confirmation of positive P. falciparum malaria on microscopy and consent. Approval was obtained from MRRH REC. Results: A total of 377 children were recruited with 76.9 % (290/377) presenting with prostration, 55.4% (209/377) jaundice, 48.5% (183/377) severe anaemia, and 46.7% (176/377) haemoglobinuria (dark or black urine) with 67.6 % above 5. Cerebral malaria constituted 7.4% (28/377) with 64.3% under 5, 23.1% (87/377) impaired consciousness, 8.2% (31/377) respiratory distress, 15.4% (58/377) acidosis, and 13.8 % (52/377) renal impairment. Majority had greater than 1 clinical form of severe malaria (88.33 %). Hyperparasitaemia constituted 19.1% (72/377), 30.6% being under 5. Mean parasite density was 136000 parasites/µl. Hyperparasitaemia was associated with thrombocytopenia AOR (95% Cl) 2.07(1.04, 4.13), p-0.039 and neutropenia AOR 2.31(1.1, 4.89), p-0.028. In hospital mortality was 3.4% (12/357) with 66.7% under 5. Case fatality due to hyperparasitaemia was 25%. Mortality was associated with deep acidotic breathing AOR (95% Cl) 8.0(1.0, 62.8) p-0.047 and renal impairment/failure AOR (95% Cl) 6.0(1.1, 34.4) p-0.044. Prolonged hospital stay was in 18 %( 68/377). No independent association was found between parasitaemia and mortality. Conclusions: Severe malaria’s still endemic in Eastern Uganda with case fatality rate of 3.4 %. Mean parasitic density was 136000 parasites/µl, and was not associated with mortality. Increase of cerebral malaria in <5, and haemoglobinuria in > 5 was noted. Dark urine was associated with renal impairment which was associated with mortality. This warrants more investigation. Keywords: Severe malaria, Hyperparasitaemia, Parasite density, severe anaemia, haemoglobinuria, Dark or black urine, renal impairment, P. falciparum malaria, Children, Uganda.

Prevalence and factors associated with poor hand hygiene practices among adult cares of children under five years in Mbale district: A cross-sectional study

Tue, 02 Jan 2024 00:00:00 GMT

Prevalence and factors associated with poor hand hygiene practices among adult cares of children under five years in Mbale district: A cross-sectional study Nawanga, Jascenti Abstract Background: While proper hand hygiene practices can reduce the risk of contracting hygiene-related diseases among children under five, incidences of poor hand hygiene practices continue to exist in the community. The reasons for this behavior are not well documented. We determined the prevalence and factors associated with poor hand hygiene practices among adult carers of children under five to inform the design of tailor-made interventions to improve hand hygiene practices among adult carers of children under five years. Methods: This was a cross-sectional study in which both quantitative and qualitative data were collected. Data collection took place in March 2023. Quantitative data were collected from 320 adult carers of children under five. Structured questionnaires were utilized to capture data on socio-demographic characteristics, household characteristics, knowledge of hand hygiene, and COVID-19 prevention practices. A carer was considered to have engaged in poor hand hygiene practice if he/she washed hands at five or less out of ten listed critical junctures. We conducted multivariable logistic regression to identify independent factors associated with poor hand hygiene practices. Factors with a p-value less than 0.05 were considered to be statistically significant to the primary outcome. Qualitative data were collected from 51 purposively selected carers identified at the end of each quantitative interview. Data were collected using focus group discussions (FGDs) and in-depth interviews to explore the barriers to and facilitators for good hand hygiene practices among the carers. Qualitative data were analyzed following a thematic framework approach, supported by the use of Atlas. ti software. Results: Of the 320 carers, 275 (85%) were females. Slightly more than one-third (38.4%, n=123) of the carers were aged 25-34 years while 55.6% (n=178) had primary education. Twenty-eight percent (n=88) of the carers had engaged in poor hand hygiene. In the multivariable analysis, significant factors were; carers who attained above primary education level (adjusted odds ratio [AOR] = 0.5; 95% Confidence Interval [95%CI]: 0.2, 0.9), carers who heard information that hand hygiene protects against COVID-19 (AOR=0.2; 95% CI: 0.04,0.8), those that had received information on hand hygiene from village health teams [VHTs] (AOR=3.0; 95% CI: 1.6, 9.8), and those who sometimes have soap or sanitizer at the place reserved for hand washing (AOR=8.8; 95% CI: 1.7, 45.5). From the qualitative findings, the facilitators of good hand hygiene were remaining free from hygiene-related disease, fear of contracting COVID-19, influence of COVID-19 lockdown and society, while the barriers were shortage of hand hygiene facilities and personal decision to engage in hand hygiene (negligence, laziness, and tiresomeness). Conclusion: Poor hand hygiene practices were prevalent among a considerable proportion of adult carers of children under five years, largely driven by receipt of hand hygiene information from VHTs, lack of time to wash hands, fatigue, and lack of hand-washing materials. These findings suggest a need for target-specific hygiene-related interventions to increase the proportion of carers who engage in proper hand hygiene practices in Mbale district. Dissertation submitted to the Directorate of Graduate Studies, Research and Innovation in Partial Fulfillment of the Requirement for the Award of the Degree of Master in Public Health of Busitema University

Factors associated with readmission of children under five years with severe maleria in Otuke District

Wed, 24 Jan 2024 00:00:00 GMT

Factors associated with readmission of children under five years with severe maleria in Otuke District Olum, James ABSTRACT. Background: Severe malaria occurs in one in every 100 clinical cases of malaria and is responsible for 619,000 deaths globally. 96% of deaths due to malaria occur in sub-Saharan Africa, and 76.8% of these deaths occur among children under the age of 5 years. The risk of readmission within 6 months, following discharge, is high among children aged 5 years and below, with a mortality for severe anaemia ranging from 16/525 (2·3%) to 48/255 (18·8%), after being discharged from hospital, or being readmitted within the first 6 months after discharge. However, data on the risk factors for readmission in rural settings is limited. Aim: To assess the factors associated with the readmission of children under five years with severe malaria within 6 months, in Otuke District, Northern Uganda. Methods: We conducted a cross-sectional study among children under 5 years admitted with severe malaria at twelve health facilities in Otuke District from 28th March 2023, to 29 May 2023, using consecutive sampling. Caregivers of children presenting with severe malaria in the study period were interviewed and asked whether they had been admitted with severe malaria in the preceding six months. This information was verified, by looking at hospital records. Data were downloaded from the kobo toolbox server, into excel, and it was analysed using Stata version 15.0 (StataCorp LLC, College Station, Texas, USA). Modified Poisson regression models were used, to estimate the prevalence ratios of the selected factors and readmission. Results: We approached 760 participants, and of these, 739/760 (97.2%) had verifiable records. Data of 739 children under 5 years were analysed. Of these, 26.8% were readmitted [198/739: (95% CI: 23.6%-30.1%)]. Factors associated with readmission with severe malaria among children under five years were: sickle cell disease [aPR: 1.71;95% CI (1.00-2.91)], residing in houses made of poor wall materials [aPR: 1.79;95% CI (1.11-2.91)], seeking care within 12 hours of onset of fever [aPR: 0.59;95% CI (0.36-0.95)], and clearing bushes around households [aPR: 0.64;95% CI (0.42-0.98)]. A total of 123 out of 198 (62.1%) children had cerebral malaria, and 31.3% (62/198) had severe anaemia at the second admission. Conclusion: The proportion of severe malaria readmission in Otuke District, Northern Uganda is high (26.8%). Factors associated with severe malaria readmission among children under five years were: sickle cell disease, residing in houses made of poor wall material, that can hide mosquitoes, and not seeking care within 12 hours. Our findings highlighted the need for follow-up and monitoring of children discharged, after severe malaria management, especially those with sickle cell disease. Keywords: Children under 5 years, re-admission, associated factors, severe malaria, Uganda, sickle cell disease. Dissertation submitted to the Directorate of Graduate Studies, Research and Innovation in Partial Fulfilment of the Requirement for the Award of the Degree of Master of Public Health of Busitema University