High postdischarge morbidity in Ugandan children with severe malarial anemia or cerebral malaria

Robert O. Opoka, Karen E.S. Hamre, Nathan Brand, Paul Bangirana, Richard Idro, Chandy John

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e41-e48
JournalJournal of the Pediatric Infectious Diseases Society
Volume6
Issue number3
DOIs
StatePublished - Sep 1 2017
Externally publishedYes

Fingerprint

Cerebral Malaria
Anemia
Morbidity
Hospitalization
Malaria
Ambulatory Care
Confidence Intervals
Outpatients
Uganda
Africa South of the Sahara
Incidence
Ambulatory Care Facilities
Nutritional Status
Inpatients
Referral and Consultation

Keywords

  • Cerebral malaria
  • Incidence
  • Readmission
  • Severe malarial anemia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases

Cite this

High postdischarge morbidity in Ugandan children with severe malarial anemia or cerebral malaria. / Opoka, Robert O.; Hamre, Karen E.S.; Brand, Nathan; Bangirana, Paul; Idro, Richard; John, Chandy.

In: Journal of the Pediatric Infectious Diseases Society, Vol. 6, No. 3, 01.09.2017, p. e41-e48.

Research output: Contribution to journalArticle

Opoka, Robert O. ; Hamre, Karen E.S. ; Brand, Nathan ; Bangirana, Paul ; Idro, Richard ; John, Chandy. / High postdischarge morbidity in Ugandan children with severe malarial anemia or cerebral malaria. In: Journal of the Pediatric Infectious Diseases Society. 2017 ; Vol. 6, No. 3. pp. e41-e48.
@article{c7cbd1d5c0e34af2b5d0d6eb303f231c,
title = "High postdischarge morbidity in Ugandan children with severe malarial anemia or cerebral malaria",
abstract = "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.",
keywords = "Cerebral malaria, Incidence, Readmission, Severe malarial anemia",
author = "Opoka, {Robert O.} and Hamre, {Karen E.S.} and Nathan Brand and Paul Bangirana and Richard Idro and Chandy John",
year = "2017",
month = "9",
day = "1",
doi = "10.1093/jpids/piw060",
language = "English (US)",
volume = "6",
pages = "e41--e48",
journal = "Journal of the Pediatric Infectious Diseases Society",
issn = "2048-7207",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - High postdischarge morbidity in Ugandan children with severe malarial anemia or cerebral malaria

AU - Opoka, Robert O.

AU - Hamre, Karen E.S.

AU - Brand, Nathan

AU - Bangirana, Paul

AU - Idro, Richard

AU - John, Chandy

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

KW - Cerebral malaria

KW - Incidence

KW - Readmission

KW - Severe malarial anemia

UR - http://www.scopus.com/inward/record.url?scp=85031789841&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031789841&partnerID=8YFLogxK

U2 - 10.1093/jpids/piw060

DO - 10.1093/jpids/piw060

M3 - Article

C2 - 28339598

AN - SCOPUS:85031789841

VL - 6

SP - e41-e48

JO - Journal of the Pediatric Infectious Diseases Society

JF - Journal of the Pediatric Infectious Diseases Society

SN - 2048-7207

IS - 3

ER -