The Predictors of Readmission or Death in Children with Cerebral Malaria and Severe Malaria Anemia.

 


Rasaq Olaosebikan1 MD, MPH, Lamuel Aigbivbalu1 MD,Chandy John2

1Department of Pediatric, The University of Texas Medical Branch, Galveston, TX

2 Indiana University School of Medicine, Indianapolis

Background

Malaria accounts for the highest cause of mortality and morbidity in sub-Saharan Africa. The highest burden of malaria is bore by children under five and pregnant women. It is estimated that 228 million malaria occurred worldwide in 2018, with Sub Saharan African accounting for 93%. Malaria can manifest in different forms, but the most devastating manifestations of malaria is Cerebral malaria (CM) and severe malaria anemia(SMA). Previous studies in western Kenya and southern Malawi indicate that not only are young children admitted to hospital for severe anemia at high risk of in-hospital mortality, but also an additional 10–16% of patients die or are readmitted in the first 3–6 months after discharge.

In patients who have received blood transfusion for SMA, new episode of malaria or recrudescent malaria after hospital discharge could negative the benefit of the transfusion leading to readmission and transfusion.

Our study set out to determine the risk of readmission and clinical predictors of readmission. Data from a large study of on Postdischarge Morbidity in Ugandan Children with Severe Malarial Anemia or Cerebral Malaria were used to identify the predictors of readmission and malaria 

Methods

Children admitted to Uganda reference Hospital in Mulago between the ages of 18 months to 12 years with diagnosis of cerebral malaria and severe malaria anemia were compared with healthy children from the community. These children were followed for 24 months. Age, sex, Prior antimalarial use, Prior antibiotics use, Socio-economic status, Maternal/paternal/child education were examined in subgroup analysis. For continuous variables, mean and standard deviation for each group were reported and compared across three groups by ANOVA. For categorical variables, frequency for each group was reported and compared across three groups by Chi-square test. When the expected cell size was less than 5 for more than 50% of cells, Fisher Exact test was used for the comparison. All of analyses were performed using SAS 9.4. 

Results 

The risk of readmission is significantly higher in the SMA and CM patients. Ten indicators for predictors of readmission were assessed out of which 5 (age, male sex, hyperparasitemia, prior use of antibiotics and prior use of antimalaria) were independent predictors of readmission. There were statistically significant more hospitalization in the SMA and the CM compared to the CC and malaria account for most admission. Clinic visit for malaria and for any illness is not difference among the three groups. 

Conclusions 

Hyperparasitemia, prior use of antibiotics or antimalaria are strong predictors of readmission in Uganda children with malaria. Malaria is the common reason for readmission and hospitalization in children with cerebral malaria and severe malaria anemia.

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