Prevalence and associated factors of severe malaria-hemoglobinuria among children below 15 years: A retrospective cross-sectional study at a tertiary regional referral hospital in Uganda.
DOI:
https://doi.org/10.51168/sjhrafrica.v6i12.2139Keywords:
Severe Malaria, Haemoglobinuria, Paediatric, Black-water feverAbstract
Background:
The World Health Organization (WHO) report of 2022 showed that Uganda accounted for 5.1% of the global case burden. Severe malaria presenting with hemoglobinuria is characterized by tea coloured urine, jaundice, and anemia. This study aimed to understand the prevalence and associated factors of severe malaria-hemoglobinuria among children below 15 years admitted to a tertiary hospital in Uganda.
Methods:
A retrospective study that involved reviewing patient files of children aged 15 years and below admitted at Kayunga regional referral hospital in Uganda during 2023. Data was extracted using a standardized checklist developed according to the WHO 2015 clinical surveillance criteria for severe malaria. Sociodemographic, clinical, and laboratory data were collected and analyzed using Stata 18. Logistic regression analysis was used to evaluate the factors associated with severe malaria-hemoglobinuria. A p-value <0.05 indicated statistical significance.
Results:
The prevalence of severe malaria-hemoglobinuria was 27.7% with the majority (48.2%) in the age group of 5-9 years. Males were the majority (54.7%). The associated factors of severe malaria-hemoglobinuria were hyperparasitemia (p-value=<0.001), convulsions (p-value=0.051), and anemia (p-value=0.012). The mortality rate among the study participants was 1.4%. The average hospitalization duration for patients was 3 days. There was no difference in mortality and duration of hospital stay among patients who received standard treatment alone versus those who received an adjuvant like steroids.
Conclusions:
The prevalence of severe malaria-hemoglobinuria was 27.7% higher than in earlier studies in central Uganda, with the overall mortality rate of 1.4%. Hyperparasitemia, anemia, and convulsions were the associated factors. The higher prevalence among children aged 5 and above highlights the need for enhanced surveillance and targeted interventions in this age group to improve outcomes in similar settings.
Recommendation:
Further prospective studies are recommended to explore causal relationships and optimize care strategies.
References
WHO Global Malaria Programme. World malaria report 2022 [Internet]. 2022. Available from: https://www.who.int/teams/global-malaria-programme
World Health Organization. Management of severe malaria: A practical handbook. Third Edition. World Health Organization; 2012. 83 p.
Namayanja C, Eregu EEI, Ongodia P, Okalebo CB, Okiror W, Okello F, et al. Unusual clinical spectra of childhood severe malaria during malaria epidemic in eastern Uganda: a prospective study. Malar J. 2023 Dec 1;22(1). https://doi.org/10.1186/s12936-023-04586-3
Opoka RO, Waiswa A, Harriet N, John CC, Tumwine JK, Karamagi C. Blackwater fever in Ugandan children with severe anemia is associated with poor postdischarge outcomes: A prospective cohort study. Clinical Infectious Diseases. 2020 Jun 1;70(11):2247-54. https://doi.org/10.1093/cid/ciz648
Ajetunmobi WA, Orimadegun AE, Brown BJ, Afolabi NK, Olabiyi FA, Anetor JI, et al. Hemoglobinuria among children with severe malaria attending tertiary care in Ibadan, Nigeria. Malar J. 2012;11. https://doi.org/10.1186/1475-2875-11-336
Paasi G, Ndila C, Okello F, Olupot-Olupot P. Predictors of prolonged hospitalization and mortality among children admitted with blackwater fever in eastern Uganda. Trop Doct. 2022 Jan 1;52(1):61-7. https://doi.org/10.1177/00494755211046782
Ministry of Health. Uganda Clinical Guidelines 2016. National Guidelines for Management of Common Conditions [Internet]. 2016. Available from: www.health.go.ug
Gobbi F, Audagnotto S, Trentini L, Nkurunziza I, Corachan M, Di Perri G. Blackwater Fever in Children, Burundi. Emerg Infect Dis [Internet]. 2005; Available from: www.cdc.gov/eid https://doi.org/10.3201/eid1107.041237
Uganda Bureau of Statistics. National Population and Housing Census 2014 [Internet]. 2016. Available from: www.ubos.org.
Namayanja C, Paasi G, Alunyo JP, Amorut D, Okalebo CB, Okiror W, et al. Epidemiology, clinical spectrum, and outcomes of severe malaria in Eastern Uganda: a prospective study. Malaria Journal. 2025 Dec 1;24(1). https://doi.org/10.1186/s12936-024-05221-5
Mseza B, Kumbowi PK, Nduwimana M, Banga D, Busha ET, Egesa WI, et al. Prevalence and factors associated with cerebral malaria among children aged 6 to 59 months with severe malaria in Western Uganda: a hospital-based cross-sectional study. BMC Pediatr. 2024 Dec 1;24(1):704. https://doi.org/10.1186/s12887-024-05178-z
Uganda Bureau of Statistics. Uganda Demographic and Health Survey 2022 [Internet]. 2023 Nov. Available from: www.ubos.org
Yeka A, Gasasira A, Mpimbaza A, Achan J, Nankabirwa J, Nsobya S, et al. Malaria in Uganda: Challenges to control on the long road to elimination. Acta Trop. 2012 Mar;121(3):184-95. https://doi.org/10.1016/j.actatropica.2011.03.004
Li J, Docile HJ, Fisher D, Pronyuk K, Zhao L. Current Status of Malaria Control and Elimination in Africa: Epidemiology, Diagnosis, Treatment, Progress and Challenges. Journal of Epidemiology and Global Health. Springer Science and Business Media B.V.; 2024. https://doi.org/10.1007/s44197-024-00228-2
Ranjha R, Singh K, Baharia RK, Mohan M, Anvikar AR, Bharti PK. Age-specific malaria vulnerability and transmission reservoir among children. Global Pediatrics. 2023 Dec;6:100085. https://doi.org/10.1016/j.gpeds.2023.100085
Ayoola O, Orimadegun A, Akinsola A, Osinusi K. A five-year review of childhood mortality at the University College Hospital, Ibadan. West Afr J Med. 2005 Oct 25;24(2). https://doi.org/10.4314/wajm.v24i2.28192
Oldenburg CE, Guerin PJ, Berthé F, Grais RF, Isanaka S. Malaria and Nutritional Status among Children with Severe Acute Malnutrition in Niger: A Prospective Cohort Study. Clinical Infectious Diseases. 2018 Sep 14;67(7):1027-34. https://doi.org/10.1093/cid/ciy207
Nauriyal D, Kumar D. Study of complex associations between severe malaria and malnutrition in the pediatric age group. Clin Epidemiol Glob Health. 2022 May;15:101065. https://doi.org/10.1016/j.cegh.2022.101065
Burkhardt J, Anemana SD, Gellert S, Cramer JP, Ehrhardt S, Laryea S, et al. Manifestation and Outcome of Severe Malaria in Children in Northern Ghana. Am J Trop Med Hyg. 2004 Aug 1;71(2):167-72. https://doi.org/10.4269/ajtmh.2004.71.167
Idro R, Marsh K, John CC, Newton CRJ. Cerebral Malaria: Mechanisms of Brain Injury and Strategies for Improved Neurocognitive Outcome. Pediatr Res. 2010 Oct;68(4):267-74. https://doi.org/10.1203/PDR.0b013e3181eee738
Huggan PJ, Ng CH, Ho J, Lin RTPV, Chavatte JM. A case of blackwater fever with persistent Plasmodium falciparum parasitemia detected by PCR after artemether-lumefantrine treatment. Malar J. 2018 Jan 16;17(1). https://doi.org/10.1186/s12936-018-2180-1
Sher A. Hemoglobinuria (Black Water Fever) in severe falciparum malaria - a case report. International Journal of Infectious Diseases. 2016 Apr;45:379. https://doi.org/10.1016/j.ijid.2016.02.812
Sher A, Latif SA. Black Water Fever in Severe Falciparum Malaria: A Case Report. Adv Infect Dis. 2022;12(01):42-9. https://doi.org/10.4236/aid.2022.121003
Raymond S, Sitompul ARH. Successful Oral Antimalarial Therapy in A 14-Year-Old Child with Blackwater Fever: A Case in a Rural Area of Asmat Regency of Papua, Indonesia. IJID Regions. 2022 Jun;3:157-9. https://doi.org/10.1016/j.ijregi.2022.03.021
Ministry of Health. Uganda Clinical Guidelines 2023 National Guidelines for Management of Common Health Conditions [Internet]. 2023 [cited 2025 Apr 17]. Available from: https://library.health.go.ug/sites/default/files/resources/Uganda%20Clinical%20Guidelines%202023.pdf
Rodari P, Tamarozzi F, Fittipaldo VA, Buonfrate D, Gobbi F. Physiopathology and clinical management of blackwater fever: a scoping review. Vol. 30, Clinical Microbiology and Infection. Elsevier B.V.; 2024. p. 59-65. https://doi.org/10.1016/j.cmi.2023.09.009
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Copyright (c) 2025 Dr. Sophia Nakitto, Dr. Egiru Emma Isaiah Eregu, Dr. Joannah Nalwoga, Zeldah Atumanya, Evelyne Namukasa, Charles Wanji Lukwago, Dr. Robert Musisi , Dr. Robert Ssentongo
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