Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study.
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 pediatri...
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| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0003794 |
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| author | Jennifer M Kniss Georget Kibaba Emmanuel Baguma Sujata Bhattarai Chhetri Cate Hendren Moses Ntaro Edgar Mulogo Samson Karabyo Ross M Boyce |
| author_facet | Jennifer M Kniss Georget Kibaba Emmanuel Baguma Sujata Bhattarai Chhetri Cate Hendren Moses Ntaro Edgar Mulogo Samson Karabyo Ross M Boyce |
| author_sort | Jennifer M Kniss |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1d03ffd7cf0e448990c1cd710be6a1fa |
| institution | OA Journals |
| issn | 2767-3375 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLOS Global Public Health |
| spelling | doaj-art-1d03ffd7cf0e448990c1cd710be6a1fa2025-08-20T01:57:40ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752024-01-01410e000379410.1371/journal.pgph.0003794Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study.Jennifer M KnissGeorget KibabaEmmanuel BagumaSujata Bhattarai ChhetriCate HendrenMoses NtaroEdgar MulogoSamson KarabyoRoss M BoycePediatric 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.https://doi.org/10.1371/journal.pgph.0003794 |
| spellingShingle | Jennifer M Kniss Georget Kibaba Emmanuel Baguma Sujata Bhattarai Chhetri Cate Hendren Moses Ntaro Edgar Mulogo Samson Karabyo Ross M Boyce Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. PLOS Global Public Health |
| title | Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. |
| title_full | Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. |
| title_fullStr | Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. |
| title_full_unstemmed | Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. |
| title_short | Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study. |
| title_sort | quality of care and post discharge morbidity among children diagnosed with severe malaria in rural uganda a prospective cohort study |
| url | https://doi.org/10.1371/journal.pgph.0003794 |
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