Underweight and mortality among children 0 to 60 months hospitalized with malaria in regions of varying malaria endemicity in Uganda

Abstract

Background: Malaria and underweight have contributed to high morbidity and mortality in children. The two conditions have the potential to co-exist, but their relationship is not well understood in Uganda. The objective of the study was to determine the prevalence of underweight, the mortality rate and the relationship between underweight and mortality among children 0 to 60 months hospitalized with malaria in regions of varying malaria endemicity in Uganda.

Methods: This multi-centre retrospective cross-sectional study was carried out using data collected during April 2010 to December 2012 from six sentinel sites having varying malaria transmission intensities, and belonging to Uganda Malaria Surveillance Program. A total of 18,564 children 0 to 60 months hospitalized with malaria, having weight and age records were studied. The Nutritional status of children was determined using WHO child growth standards. Underweight was measured using weight-for-age z-scores. Binary logistic regression was used to assess for the relationship between underweight and mortality.

Results: The prevalence of underweight was 23% (95% CI: 22.7-23). Regions of low malaria transmission levels had highest prevalence of both moderate underweight (16.9%, 95%CI: 13.8-20.0) and severe underweight (11.3, 95% CI: 8.7-13.9). Mortality rate was 1.8% and was highest among children from areas of moderate malaria transmission levels (2.4%, 95%CI: 2.1-2.7). Moderate underweight [OR: 1.5, 95% CI: 1.3-1.7, p-value: ≤0.001] as well as severe underweight [OR: 3.0, 95% CI: 2.2 – 4.1, p-value: ≤0.001] were significantly and deleteriously associated with all-cause mortality.

Conclusions: The prevalence of under-weight among children 0 to 60 months hospitalized with malaria was high at 23%. Areas of low malaria transmission had the greatest number of children with underweight. All-cause mortality rate was high at 1.8%, and was highest among children from areas of moderate malaria transmission levels. Severely underweight children had a three-fold increase in risk of dying compared to children with normal weight-for-age. These findings call for the strengthening of the policy of screening all hospitalized children for malnutrition and taking appropriate action. The disproportionately high number of children with underweight in areas of low malaria transmission calls for further research to better understand the relationship between underweight and mortality in low malaria transmission.