Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study

Pediatric severe malaria significantly impacts morbidity and mortality rates in Uganda, with most data originating from urban tertiary referral centers. This study aimed to address the knowledge gap regarding routine care and post-discharge outcomes in rural settings. A longitudinal cohort study was conducted at St. Paul’s Level IV Health Center (SPHC) in Kasese, Uganda, including 187 children aged 0 to 17 years between July 2023 and January 2024. Almost all participants (94.7%) had a parasitologically confirmed malaria diagnosis. During their stay at SPHC, 95.7% received intravenous Artesunate and 92.0% oral antimalarials. Symptoms of severe malaria were present in 62.0% of patients, with altered consciousness and convulsions being the most common. Severe malarial anemia was observed in 26.1% of patients, the majority of whom received blood transfusions. Care at SPHC was largely in line with WHO guidelines (82.2%). Post-discharge follow-up revealed that 25.6% of patients experienced ongoing symptoms, with fever and feeding issues being the most prevalent. Notably, altered consciousness during acute illness increased the risk of post-discharge symptoms (aRR: 1.69). Six deaths were recorded overall. These findings highlight the consistency of treatment with guidelines at rural facilities but also underline the need for further research on post-discharge morbidity.