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

Abstract

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.