Post-Discharge Sequelae of Severe Malaria Among Pediatric Patients in Western Uganda

Uganda bears the third highest malaria mortality rate globally, with the burden falling disproportionately on children. Most malaria-related deaths occur after progression to severe malaria (SM), which is often fatal without timely treatment. Compared to in-hospital care of SM, the post-discharge period has received relatively little attention. A study by the MUST-UNC collaboration found 25.6% of children hospitalized for SM in western Uganda reported persistent symptoms after discharge. Therefore, we modified the study to extend follow-ups to be biweekly and incorporate home visits contingent on symptom persistence. We sought to (i) estimate the prevalence and characterize persistent symptoms at 14-, 28, and 42-days post-discharge, and (ii) identify demographic, household, and clinical risk factors associated with these outcomes. We found that 85.25% of participants had at least one additional diagnosis to malaria. All children with comorbidities reported persistent symptom at 14 days, with sickle cell disease (SCD) emerging as a significant risk factor – possibly due to either increased complication risk or underrecognized regional prevalence of SCD. Additionally, leukocytosis in half of participants and the association of respiratory distress with symptom persistence suggests respiratory infections, including bacterial coinfections, contribute. These findings highlight the need for integrated post-discharge care that addresses not only the initial illness, but also comorbidities and coinfections. In high-burden settings, targeted interventions for children with chronic illnesses or nutrient deficiencies may be particularly effective in reducing post-discharge morbidity.