Quality of Care and Post-discharge Morbidity among Children Diagnosed with Severe Malaria in Rural Uganda: A prospective cohort study
| dc.contributor.author | Kniss, Jennifer M. | |
| dc.contributor.author | Baguma, Emmanuel | |
| dc.contributor.author | Ntaro, Moses | |
| dc.contributor.author | Mulogo, Edgar | |
| dc.contributor.author | Karabyo, Samson | |
| dc.contributor.author | Boyce, Ross M. | |
| dc.date.accessioned | 2025-09-23T09:04:01Z | |
| dc.date.available | 2025-09-23T09:04:01Z | |
| dc.date.issued | 2024-10-07 | |
| dc.description.abstract | Pediatric severe malaria is a significant contributor of morbidity and mortality in Uganda. Most information is derived from tertiary referral centers and urban centers. Little is known about routine care or post-discharge outcomes in rural areas. We conducted a longitudinal cohort study of pediatric severe malaria at St. Paul’s Level IV Health Center (SPHC) in Kasese, Uganda. We collected demographic, clinical, and laboratory results, and conducted follow-up 14 days post-discharge to assess patient outcomes in the immediate post-discharge period. The initial cohort included 187 children aged 0 to 17 years enrolled between July 9th, 2023 and January 9th, 2024. Almost all (94.7%) participants had a parasitological confirmed malaria diagnosis by rapid diagnostic tests or blood smear. While at SPHC, 95.7% of patients received 3+ doses of intravenous Artesunate, and 92.0% also received oral antimalarials. 62.0% had at least one symptom of severe malaria, with altered consciousness (40.6%) and convulsions (29.9%) the most frequently reported. 26.1% had evidence of severe malarial anemia (Hb <5 g/dl), of whom 93.5% received a blood transfusion. Most (82.2%) patients received care that we assessed as consistent with key elements of WHO management guidelines. We were able to contact 183 of the 187 patient caregivers post-discharge. Caregivers reported that 25.6% of patients were experiencing symptoms related to their hospitalization, with fever (18.5%) and nausea/ not feeding well (10.3%) reported most frequently. Children who experienced altered consciousness during their acute illness had 1.69 times the adjusted risk of reporting symptoms 14-days post-discharge compared to those who did not have altered consciousness (aRR: 1.69, 95% CI: 1.01–2.82). Six deaths were recorded, including three at SPHC and three post-transfer or discharge. Findings suggest that at private health facilities in rural areas, treatment appears to be consistent with guidelines. Future research should investigate high morbidity in the immediate post-discharge period. | |
| dc.identifier.citation | Kniss, J. M., Kibaba, G., Baguma, E., Bhattarai Chhetri, S., Hendren, C., Ntaro, M., ... & Boyce, R. M. (2024). Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. PLOS Global Public Health, 4(10), e0003794. | |
| dc.identifier.other | https://doi.org/10.1371/journal.pgph.0003794 | |
| dc.identifier.uri | https://nru.uncst.go.ug/handle/123456789/12096 | |
| dc.language.iso | en | |
| dc.publisher | PLOS Global Public Health | |
| dc.title | Quality of Care and Post-discharge Morbidity among Children Diagnosed with Severe Malaria in Rural Uganda: A prospective cohort study | |
| dc.type | Article |