Outcomes and factors associated with acute kidney injury among children with severe malaria at Kiryandongo General Hospital, Uganda
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Date
2021-11
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Kampala International University
Abstract
Background: Malaria remains one of the leading health problems of the developing world, and acute kidney injury (AKI) is a well-recognized complication of severe malaria in adults; but the clinical importance of AKI in pediatric severe malaria is not well documented. Knowledge of the prevalence, outcomes and factors associated among children with severe malaria is the mainstay strategy, which can help to reduce the burden of AKI among this vulnerable group. Methods: A hospital based prospective cohort and analytic study of children with severe malaria was carried out at Kiryandongo General Hospital. The study involved 350 children with severe malaria attending the study site from August to October 2021. Questionnaires were administered to caretakers to obtain socio-demographic. Medical data was obtained by carrying out a through physical examination followed by laboratory tests. Blood samples were tested for creatinine and blood smear for malaria. Data were analyzed using univariate, bivariate and multivariate logistic regression analyses to determine the prevalence and factors associated with acute kidney injury among children with severe malaria. Result: The mean age of children with severe malaria was 7.0 ± 3.8 years and 54.3 % of them were male.Of the 350 children enrolled in the study with severe malaria, 167 had AKI, giving an overall AKI prevalence of 47.7% (95% CI: 42.5-53.0). The factors that were significantly associated with AKI among children with severe malaria included: caretaker with no formal education (aOR= 21.0, 95% CI: 1.68 – 261.18, p= 0.018); caretaker with primary education level (aOR= 4.5, 95% CI: 1.41 – 14.12, p= 0.011); age of child < 5years (aOR= 1.8, 95% CI: 1.07 – 2.88, p= 0.025); history of receiving NSAIDs (aOR= 5.6, 95% CI: 2.34 – 13.22, p <0.001); moderate anemia (aOR= 3.1, 95% CI: 1.39 – 6.94, p= 0.006) and severe anemia (aOR= 3.8, 95% CI: 1.66 – 8.55, p= 0.002). Sixteen of 167 with AKI died (9%) during follow up and the mean lengh hospital stay was of 5 days. Conclusion: The prevalence of acute kidney injury was high as well as mortality rate of AKI among children with severe malaria still high, in Kiryandongo General Hospital. Acute kidney injury among children with severe malaria was associated with low level of education of caretakers, young age of children (less than 5 years), history of receiving NSAIDs and anemia. The management of severe malaria should include screening for AKI especially in children under five years of age, anaemic and those who have received NSAIDs.