title: High prevalence of malaria parasitemia and anemia among hospitalized children in Rakai, Uganda.
abstract: BACKGROUND
  There is a paucity of data on malaria among hospitalized children in malaria endemic areas. We determined the prevalence, presentation and treatment outcomes of malaria and anemia among children in two hospitals in Rakai, Uganda.
  
  
  METHODS
  Children under five years hospitalized in Kalisizo hospital or Bikira health center in Rakai district, Uganda between May 2011 and May 2012 were enrolled and followed-up until discharge, death or referral. Data were collected on social-demographic characteristics, current and past illnesses and clinical signs and symptoms. Blood smears, hemoglobin (Hgb) levels and HIV testing were performed from finger/heel prick blood. The associations between malaria infection and other factors were estimated using log-binomial regression to estimate adjusted prevalence risk ratios (aPRR) and 95% confidence intervals (CIs), controlling for clustering at health facilities.
  
  
  RESULTS
  2471 children were enrolled. The most common medical presentations were fever (96.2%), cough (61.7%), vomiting (44.2%), diarrhea (20.8%), and seizures (16.0%). The prevalence of malaria parasitemia was 54.6%. Children with malaria were more likely to present with a history of fever (aPRR 2.23; CI 1.18-4.24) and seizures (aPRR 1.12; CI 1.09-1.16). Confirmed malaria was significantly lower among girls than boys (aPRR 0.92; CI 0.91-0.93), HIV infected children (aPRR 0.60 CI 0.52-0.71), and children with diarrhea (aPRR 0.76; CI 0.65-0.90). The overall prevalence of anemia (Hgb<10 g/dl) was 56.3% and severe anemia (Hgb<6 g/dL) was 17.8%. Among children with severe anemia 76.8% had malaria parasitemia, of whom 93.1% received blood transfusion. Malaria associated mortality was 0.6%.
  
  
  CONCLUSIONS
  There was a high prevalence of malaria parasitemia and anemia among inpatient children under five years. Malaria prevention is a priority in this population.
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda.
authors.forename: Valerian L
authors.initials: VL
authors.lastname: Kiggundu
authors.affiliation: Department of Medicine, Duke University School of Medicine and Duke Global Health Institute, Durham North Carolina, United States of America.
authors.forename: Wendy P
authors.initials: WP
authors.lastname: O'Meara
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Musoke
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda.
authors.forename: Fred K
authors.initials: FK
authors.lastname: Nalugoda
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda.
authors.forename: Enos
authors.initials: E
authors.lastname: Baghendaghe
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.affiliation: East African IeDEA (International Epidemiological Data Bases to Evaluate AIDS) and Infectious Diseases Institute Makerere University College of Health Sciences, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Marion K
authors.initials: MK
authors.lastname: Achienge
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda ; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda ; Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Makumbi
authors.affiliation: Rakai Health Sciences Program, Kalisizo-Station, Kalisizo, Rakai, Uganda ; Makerere University School of Public Health, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland, United States of America.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
authors.forename: Kara K
authors.initials: KK
authors.lastname: Wools-Kaloustian
mesh_terms: D000740:Anemia / Q000453:epidemiology*; D001803:Blood Transfusion; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015897:Comorbidity; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D018512:Parasitemia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology