High Postdischarge Morbidity in Ugandan Children With Severe Malarial Anemia or Cerebral Malaria.
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.
Departments of Paediatrics.
Robert O
RO
Opoka
Division of Global Pediatrics, University of Minnesota, Minneapolis.
Karen E S
KES
Hamre
Columbia College of Physicians and Surgeons, New York.
Nathan
N
Brand
Psychiatry, Makerere University, Kampala, Uganda.
Paul
P
Bangirana
Departments of Paediatrics.
Richard
R
Idro
Division of Global Pediatrics, University of Minnesota, Minneapolis.|Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University, Indianapolis.
Chandy C
CC
John
D000740:Anemia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000150:complications / Q000453:epidemiology*; D016778:Malaria, Falciparum / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D010351:Patient Discharge; D012017:Referral and Consultation; D012720:Severity of Illness Index; D012923:Social Class; D014454:Uganda / Q000453:epidemiology
cerebral malaria; incidence; readmission; severe malarial anemia