Severe malaria readmissions in Northern Uganda: a cross-sectional study

James Olum; David Mukunya; Brendah Nambozo; Ritah Nantale; Faith Oguttu; Joshua Epuitai; Ivan Lume; Benon Wanume; Peter Olupot-Olupot; Daphine Amanya; Abel Kakuru

doi:10.1186/s12936-025-05307-8

Severe malaria readmissions in Northern Uganda: a cross-sectional study

Malar J. 2025 Feb 27;24(1):64. doi: 10.1186/s12936-025-05307-8.

Authors

Affiliations

¹ Department of Community and Public Health, Faculty of Health Sciences, Busitema University, PO Box 236, Tororo, Uganda.
² Department of Community and Public Health, Faculty of Health Sciences, Busitema University, PO Box 236, Tororo, Uganda. 262nbrendah@gmail.com.
³ Department of Peadiatrics, Mbale Regional Referral Hospital, Mbale, Uganda.
⁴ Department of Nursing, Faculty of Health Sciences, Busitema University, PO Box 236, Tororo, Uganda.
⁵ Department of Internal Medicine, Faculty of Health Sciences, Busitema University, PO Box 236, Tororo, Uganda.
⁶ Mbale Clinical Research Institute, Pallisa Road, PO Box 291, Mbale, Uganda.

Abstract

Background: Malaria is a critical global health issue, particularly for children in endemic regions. However, factors associated with recurrent severe malaria in children under 5 years of age in Northern Uganda are poorly understood. This study aimed to identify factors associated with readmission due to severe malaria within six months post-discharge among children in this age group.

Methods: A cross-sectional study was conducted in Otuke district, encompassing twelve health facilities. A total of 760 caregivers of children admitted with severe malaria were interviewed, and hospital records were reviewed to verify the readmission data. The primary outcome assessed was readmission with severe malaria within six months after initial discharge. Data analysis was performed via Stata version 15.0.

Results: The prevalence of readmission with severe malaria among children under 5 years of age was 26.8% (198/739). Factors significantly associated with readmission included having sickle cell anaemia [adjusted prevalence ratio (aPR) 1.72; 95% confidence interval (CI) (1.95-3.14)], living in houses constructed with straw and thatch walls [(aPR 2.10; 95% CI (1.19-3.69)] and seeking care after 12 h when the child has a fever [aPR 2.01; 95% CI (1.23-3.29)].

Conclusion: The findings indicate a high proportion of severe malaria readmissions in children under 5 years of age. Sickle cell anaemia, living in houses built using straw and thatch walls and seeking care after 12 h when a child has fever were the key risk factors for readmission with severe malaria. This study highlights the importance of targeted post-discharge interventions, such as prophylactic anti-malarials in addition to bed nets, to prevent recurrent infections especially among children with sickle cell disease. In addition, improvements in housing quality and timely treatment of children with malaria are essential for reducing the burden of malaria, particularly in endemic regions.

Keywords: Associated factors; Children; Children under 5 years of age; Readmission; Severe malaria; Uganda.

MeSH terms

Child, Preschool
Cross-Sectional Studies
Female
Humans
Infant
Infant, Newborn
Malaria* / epidemiology
Male
Patient Readmission* / statistics & numerical data
Prevalence
Risk Factors
Uganda / epidemiology