Severe falciparum malaria in young children is associated with an increased risk of post-discharge hospitalization: a prospective cohort study.

Background: Few studies have described post-discharge morbidity of children with specific manifestations of severe malaria (SM) beyond severe malarial anaemia or cerebral malaria.

Methods: Children 6 months to 4 years of age admitted at Jinja and Mulago hospitals in Uganda, with one or more of the five most common forms of SM, cerebral malaria (n = 53), respiratory distress syndrome (n = 108), malaria with complicated seizures (n = 160), severe malarial anaemia (n = 155) or prostration (n = 75), were followed for 12 months after discharge, alongside asymptomatic community children (CC) (n = 120) of similar ages recruited from the households or neighbourhoods of the children with SM. Incidence and risk of hospitalizations, death or outpatient clinic visits were compared between children with SM and CC.

Results: 312/551 (56.6%) of children with SM had one or more post-discharge hospitalization over 12 months, compared to 37/120 (30.8%) of CC. Frequency of hospitalization was similar across all forms of SM. Compared to CC, children with SM had a significantly higher risk of all-cause hospitalization (adjusted hazard ratio (aHR) 1.91, 95% confidence interval (CI) 1.39-2.63, p < 0.001) and hospitalization for severe malaria (aHR 1.94, CI 1.36-2.78, p < 0.001), but a similar risk of outpatient clinic visits for malaria (aHR 1.24, 95% CI 0.89-1.73, p = 0.20). 82% of hospitalizations in children with SM (575/700) and CC (50/61) were due to malaria.

Conclusions: In this malaria endemic region, children with the five most common forms of SM had higher rates of post-discharge hospitalization than asymptomatic community children, and > 80% of hospitalizations were due to severe malaria. Studies of post-discharge malaria chemoprevention are urgently needed for children with SM, to determine if this treatment can reduce post-discharge morbidity.