Predictors of outcomes for children with severe malaria admitted at Mchinji district hospital in Malawi

Fosiko, Nedson Given
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Introduction: Knowing the burden of severe malaria in children and the predictors of outcomes for children with severe malaria would help to put up interventions that would reduce the risk of poor outcomes and promote survival. Aim: The aim of this study was to determine the predictors of outcomes for the children with severe malaria admitted at Mchinji district hospital, in Malawi. Methods: This was a cross sectional study and 201 randomly sampled files of children admitted to Mchinji district hospital with severe malaria in 2013 and 2014 were reviewed. Univariate and multivariate logistic regression models were used to predict outcomes for the children with severe malaria. Results: During the study period there were 2603(N) children admitted with severe malaria. A sample of 202 (n) files for children admitted with malaria was randomly selected, and 201(n) were included in the final analysis. The majority of the children were under the age of five years 155 (78.3%), 106 (53.5%) were male, with 147 (73.1%) being self-referrals and 54 (26.9%) health centre referrals. Fever was the most common presenting complaint, 177 (88.1%), while 76 (37.8%) had convulsions and 58 (28.9%) had vomiting. All patients were treated as per Malawi National Malaria Control Program treatment guidelines. The outcomes of the children were either discharged home alive, died, missing (referred to a specialised unit, or absconded from hospital). The case fatality rate was 7.5%. Of the children that died 11 (73.3%) were children under the age of five years and 9 (60%) were children referred from the health centre. Children who were referred from the health centres were more likely to die than children who were self referred by guardians from their homes [OR=4.84 1.63-14.35] Conclusion and Recommendations: The study found that being referred from health centre, presenting with unconsciousness, long stay in hospital and receiving LA in the course of treatment are predictors of outcomes in children admitted with severe malaria. The predictors are a combination of patient and health systems factors that influence delay in accessing prompt treatment for malaria in general. Therefore, there is need to improve patient care right from home and in the hospital with special attention on the patient referral system. Further research on community and health system factors to improve the system for caring of children with malaria may be required.
A research Report submitted to the faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Rural Health Johannesburg, June, 2017.