Unusual Clinical Spectra of Childhood Severe Malaria During Malaria Epidemic in Eastern Uganda: A Prospective Study

Abstract

Background In sub-Saharan Africa (SSA), malaria remains a public health problem despite recent reports of declining incidence. Severe malaria is a multiorgan disease with wide-ranging clinical spectra and outcomes that have been reported to vary by age, geographical location, transmission intensity over time. There are reports of recent malaria epidemics or resurgences, but few data, if any, focus on the clinical spectrum of severe malaria during epidemics. We describe the clinical spectrum and outcomes of childhood severe malaria during the disease epidemic in Eastern Uganda. Methodology: This prospective cohort study from October 1, 2021, to September 30, 2022, was nested within the Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda (TMA2016SF-1514-MEPIE Study) at Mbale Regional Referral Hospital, Uganda. Children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the clinical WHO criteria for surveillance of severe malaria were enrolled on the study. Follow-up was performed until day 28. Data were collected using a customised proforma on social demographic characteristics, clinical presentation, treatment, and outcomes. Laboratory analyses included complete blood counts, malaria RDT (SD BIOLINE Malaria Ag P.f/Pan, Ref. 05FK60-40-1) and blood slide, lactate, glucose, blood gases and electrolytes. In addition, urinalysis using dipsticks (Multistix® 10 SG, SIEMENS, Ref.2300) at the bedside was done. Data were analysed using STATA V15.0. The study had prior ethical approval. Results A total of 300 participants were recruited. At admission, the median age was 4.6 years (range two months − 11.8 years). Many children, 164/300 (57.7%,) were under five years, and 171/300 (57.0%) were males. The common clinical features were prostration 236/300 (78.7%), jaundice in 205/300 (68.3%), severe malarial anaemia in 158/300 (52.7%), blackwater fever 158/300 (52.7%) and multiple convulsions 51/300 (17.0%). Prolonged hospitalisation was found in 56/251 (22.3%) and was associated with hypoxaemia OR 6.3 (95% CI: 2.1, 18.1), P = 0.001. The overall mortality was 19/300 (6.3%). Day 28 follow-up was achieved in 247/300 (82.3%). Conclusion During a 2022 malaria epidemic in Eastern Uganda, the common clinical features for childhood severe malaria were prostration 236/300 (78.7%), jaundice 205/300 (68.3%), severe malarial anaemia 158/300 (52.7%), blackwater fever 158/300 (52.7%) and multiple convulsions 51/300 (17.0%).