Severe falciparum malaria in young children is associated with an increased risk of post-discharge readmission or death: A prospective cohort study.

Introduction: Few studies have described post-discharge morbidity of children with specific manifestations of severe malaria (SM) beyond severe malarial anemia 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 manifestations of SM, cerebral malaria (n=53), respiratory distress syndrome (n=108), malaria with complicated seizures (n=160), severe malarial anemia (n=155) or prostration (n=75), were followed for 12 months after discharge, along with community children (CC) (n=120) recruited from the household or neighborhood of the children with SM. Incidence and risk of post-discharge readmission, 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 readmission, compared to 37/120 (30.8%, p<0.001) of CC. Frequency of readmission was similar across all forms of SM. Compared to CC, children with SM had significantly higher risk of post-discharge readmission or death (adjusted hazard ratio (aHR) 2.06, 95% confidence interval (CI) 1.51-2.81, p<0.001), but a similar risk of outpatient malaria (aHR 1.30, 95% CI 0.97-1.74, p=0.08). 82% of readmissions in children with SM were due to malaria. Conclusions: In this malaria endemic region, children with the most common forms of SM had higher rates of post-discharge readmission or death than CC, and >80% of readmissions were due to malaria. Studies of post-discharge malaria chemoprevention are urgently needed for children with SM, to determine if this treatment can reduce post-discharge morbidity and mortality.