Prevalence and factors associated with cerebral malaria amongst children aged 6 to 59 months with severe malaria at Fort Portal Regional Referral Hospital
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Date
2023-03
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Kampala International University; Faculty of Cinical Medicine and Dentistry
Abstract
Introduction
Malaria is among the commonest childhood febrile illness in Sub-Saharan Africa. One of the severe types of malaria, referred to as cerebral malaria, has been associated with a high morbidity and mortality. Despite the high mortality, the prevalence of cerebral malaria among children with severe malaria in Uganda is not well documented and contributing factors are still not well understood. This study aimed at determining the prevalence and factors associated with cerebral malaria amongst hospitalized children aged 6 to 59 months with severe malaria in the paediatric ward of Fort Portal Regional Referral Hospital (FPRRH).
Methods
This was a cross-sectional, descriptive and analytical study that enrolled 250 children aged 6 to 59 months with severe malaria in the paediatric ward of FPRRH. Socio-demographic variables of the child and caretakers were obtained using a structured questionnaire and patient’s medical record. After the physical examination, blood was collected from each study participants for complete blood count (CBC), Renal function test and serum electrolyte. A peripheral blood smear was done using capillary blood obtained by finder prick. Data were entered and analysed using IBM SPSS 27.0 statistics for windows. The prevalence of cerebral malaria amongst children with severe malaria were determined as proportions, whereas binary logistic regression was used to determine factors associated with cerebral malaria. A p-value <0.05 was considered for statistical significance at multivariable level.
Results
Of the 250 children enrolled, the prevalence of cerebral malaria was 12.8% (95% C.I: 8.9-17.6). The factors that were independently associated with cerebral malaria were male gender (aOR: 3.05, 95%C.I: 1.20-7.77, p=0.02), having five children or more (aOR: 5.95, 95% C.I:1.64-21.59, p= 0.01), history of convulsions (aOR: 12.20, 95% C.I:10.7-21.69, p=0.03); prostration (aOR: 11.13, 95%C.I: 1.68-23.80, p=0.01); abnormal bleeding (aOR: 13.22,95%C.I: 11.54-15.16, p=0.001), acute kidney injury (aOR: 4.50, 95% C.I: 1.30-15.53, p=0.02) and hyponatremia (aOR: 3.47, 95% C.I: 1.34-8.96, p=0.010).
Conclusion:
Amongst children aged 6 to 59 months with severe malaria at a regional referral hospital in Western Uganda, one in 8 children had cerebral malaria. This prevalence is similar to what other studies in sub-Saharan Africa have reported in the same age group. The factors associated with cerebral malaria were male gender, having five siblings or more, history of convulsions and other manifestation of severe malaria such as prostration, abnormal bleeding, acute kidney injury and hyponatremia. In addition to early initiation of antimalarial therapy other clinical and laboratory manifestations of severe malaria should be properly investigated and adequately treated to reduce the risk of cerebral malaria in young children.