The clinical spectrum of severe malaria has not been described in Bushenyi, hence; this study was carried out to document the prevalence, major clinical features, contributing factors and immediate outcome of this number one killer disease of under-five children, at Kampala International University Teaching Hospital (KIUTH). This is a pilot study. Study design was retrospective; carried out in the records department of KIUTH; the study population were files of children, 5 years of age and below who attended KIUTH between August and October 2009, sample size was 100 using systematic random sampling. Ethical clearance and permission were obtained. Data was collected using checklist, entered into Epi-Info version 3.2 and analysed with SPSS 16 statistical software. Prevalence of complicated malaria was 29.8%. Male: female ratio was 1.33:1. Peak age was 3years, 78% of the children had no wasting and 62% slept under treated bed nets. The three most common presentations were febrile multiple convulsions (69%), hyperparasitemia (67%) and circulatory shock (59%), prolonged coma was the least presentation (30%). The infants most commonly present with severe anaemia (60%), while the older ones manifest usually with febrile multiple convulsions (76.9%). Mortality rate was 14%, higher in the malnourished (27.3%), boys (19.3%), age 5year bracket (23.1%), with hypoglycaemia (18.8%), respiratory distress (17.9%) and multiple febrile convulsions (17.4%). The prevalence and mortality from severe malaria was high. The most common presentations were multiple febrile convulsions, hyperparasitaemia and circulatory shock. Immediate outcome was significantly affected by the nutritional status. A larger study will be done in future for a more complete picture of this problem.

Background The BFHI program and timely breastfeeding initiation may be threatened by the worldwide rise in cesarean section deliveries, and this might promote prelacteal feeding. What is the current burden and determinants of delayed breastfeeding initiation among mothers, who gave birth via cesarean section? Subject and methods This was the baseline data of a prospective cohort study, where 529 healthy, singleton mother-newborn pairs were recruited consecutively at birth, from Gitwe district hospital in Rwanda. Results Overall, the burden of cesarean section delivery, delayed initiation of breastfeeding and prelacteal feeding were 38.8%, 17.0% and 6.0%, respectively. Rate of delayed breastfeeding initiation among mothers, who delivered by cesarean section was 37.6%, compared to 4.0% among those that delivered vaginally, p<0.001. Prelacteal feeds were given to 12.7% of the babies that were delivered by cesarean section, compared to 1.9% among those delivered vaginally, p<0.001. Use of probably unsafe water sources located in the household yards was strongly linked to both cesarean section delivery (p<0.000; OR=5.71; 95%CI=2.43, 13.41) and delayed breastfeeding initiation (p<0.000; OR=44.40; 95% CI 7.97, 247.32). Mothers delivered by c-section, who were prenatally exposed to potentially harmful substances, were more likely to delay breastfeeding initiation compared to unexposed mothers (p=0.001; OR=3.14; 95% CI 1.56, 6.31). Cesarean section delivery was more likely with HIV positive mothers (p=0.010; OR=7.14; 95% CI:1.61, 33.33), teenage and entrepreneur mothers. Rate of cesarean section delivery amongst HIV positive mothers was 88.9%, compared to 36.1% among HIV negative mothers. Conclusion and Recommendations HIV positivity and non-medical causes still drive the over-use of cesarean section for delivery in this rural community, and this impacted negatively on breastfeeding initiation, thereby promoting prelacteal feeding. The uncertain safety of the water sources and prenatal exposures to harmful social habits also need to be addressed. KEY WORDS: Breastfeeding initiation, cesarean section delivery, prelacteal feeds, unsafe water, antenatal breastmilk expression.