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1.
World Health Organization , Improving Health Literature. Available at: https://www.who.int/activities/improving-health-literacy. Accessed April 22, 2023.
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Bilinski A et al., 2017. Distance to care, enrollment and loss to follow-up of HIV patients during decentralization of antiretroviral therapy in Neno District, Malawi: a retrospective cohort study. PLoS One 12: e0185699.
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Frijters EM, Hermans LE, Wensing AM, Devillé WL, Tempelman HA, De Wit JB, 2020. Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries. AIDS 34: 1261–1288.
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Webb S, 2018. A retrospective notes-based review of patients lost to follow-up from anti-retroviral therapy at Mulanje Mission Hospital, Malawi. Malawi Med J 30: 73–78.
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Mpinganjira S, Tchereni T, Gunda A, Mwapasa V, 2020. Factors associated with loss-to-follow-up of HIV-positive mothers and their infants enrolled in HIV care clinic: a qualitative study. BMC Public Health 20: 1–10.
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Ankunda R, Cumber SN, Atuhaire C, Kabanda T, Nkfusai CN, Wirsiy FS, Turyakira E, 2020. Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study. BMC Infect Dis 20: 1–9.
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Steinbrook E et al., 2021. Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study. BMC Pregnancy Childbirth 21: 1–11.
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Nkhonjera J, Suwedi-Kapesa LC, Kumwenda B, Nyondo-Mipando AL, 2021. Factors influencing loss to follow-up among human immunodeficiency virus exposed infants in the Early Infant Diagnosis Program in Phalombe, Malawi. Glob Pediatr Health 8: 2333794X211004166.
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Tweya H, Oboho IK, Gugsa ST, Phiri S, Rambiki E, Banda R, Mwafilaso J, Munthali C, Gupta S, Bateganya M, 2018. Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi. PLoS One 13: e0188488.
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12.
Rachlis B, Ahmad F, van Lettow M, Muula AS, Semba M, Cole DC, 2013. Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi. BMC Health Serv Res 13: 1–11.
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Birbeck GL, Molyneux ME, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, Taylor TE, 2010. Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol 9: 1173–1181.
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14.
Postels DG, Taylor TE, Molyneux M, Mannor K, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, Birbeck GL, 2012. Neurologic outcomes in retinopathy-negative cerebral malaria survivors. Neurology 79: 1268–1272.
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Christensen SS, Eslick GD, 2015. Cerebral malaria as a risk factor for the development of epilepsy and other long-term neurological conditions: a meta-analysis. Trans R Soc Trop Med Hyg 109: 233–238.
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Loss to Hospital Follow-Up in Pediatric Cerebral Malaria Survivors: A Case-Control Study
Carolyn Ramwell
Carolyn Ramwell
Division of Cardiology, Children’s National Hospital, Washington, District of Columbia;
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Alice M. Liomba
Alice M. Liomba
Blantyre Malaria Project, Blantyre, Malawi;
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Mrinmayee Takle
Mrinmayee Takle
Division of Neurology, Children’s National Hospital, Washington, District of Columbia;
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John R. Barber
John R. Barber
Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, District of Columbia;
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Lucinda Manda-Taylor
Lucinda Manda-Taylor
School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Cara Pleau
Cara Pleau
Division of Cardiology, Children’s National Hospital, Washington, District of Columbia;
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Douglas G. Postels
Douglas G. Postels
Blantyre Malaria Project, Blantyre, Malawi;
Division of Neurology, Children’s National Hospital, Washington, District of Columbia;
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Division of Neurology, Children’s National Hospital, Washington, District of Columbia;
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ABSTRACT.
Children surviving central nervous system (CNS) infections are at high risk of neurological, behavioral, and cognitive sequalae. Early identification, characterization, and treatment of these sequelae may improve child and family health. In Africa, it is unclear if there are demographic or clinical factors that increase the risk of post-hospital loss to follow-up in children with CNS infections. If these factors exist, targeted educational efforts to increase rates of post-hospital retention could be focused on families at highest risk. We performed a case-control study of Malawian children with cerebral malaria, a locally common CNS infection, previously admitted to a specialized research unit in Blantyre, Malawi. Routine survivor post-hospital follow-up was scheduled for 1 month, 6 months, and 12 months. We compared demographic and clinical characteristics between 84 children who missed one or more of these post-hospital visits with 120 children who attended all visits. There were no statistically significant differences in demographic or clinical characteristics between children whose families returned for all follow-up visits and those who did not. Specifically, when comparing these groups, we found no differences in age (P = 00.646), sex (P = 0.789), duration of hospitalization (P = 0.903), distance from home to hospital (P = 0.355), type or severity of neurological sequelae (P = 0.837), guardian literacy (P = 0.057), or number of discharge medications (P = 0.464). No factors assessed in this study were associated with higher risk of loss to follow-up in Malawian child survivors of CNS infections. During hospitalization, educational efforts to increase post-hospital retention should focus on all families.
Author Notes
This work was supported by internal funding through the Global Health Initiative at Children’s National Hospital (Washington, District of Columbia).
Authors’ addresses: Carolyn Ramwell and Cara Pleau, Division of Cardiology, Children’s National Hospital, Washington, District of Columbia, E-mails: cbramwell@childrensnational.org and cpleau@childrensnational.org. Alice M. Liomba, Blantyre Malaria Project, Blantyre, Malawi, E-mail: wanguialice@gmail.com. Mrinmayee Takle, Division of Neurology, Children’s National Hospital, Washington, District of Columbia, E-mail: mtakle@childrensnational.org. John R. Barber, Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, District of Columbia, E-mail: jrbarber@childrensnational.org. Lucinda Manda-Taylor, Kamazu University of Health Sciences, Blantyre, Malawi, E-mail: mandal@kuhes.ac.mw. Douglas G. Postels, Blantyre Malaria Project, Blantyre, Malawi, and Division of Neurology, Children’s National Hospital, Washington, District of Columbia, E-mail: dpostels@childrensnational.org.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , Improving Health Literature. Available at: https://www.who.int/activities/improving-health-literacy. Accessed April 22, 2023.
-
2.
Bilinski A et al., 2017. Distance to care, enrollment and loss to follow-up of HIV patients during decentralization of antiretroviral therapy in Neno District, Malawi: a retrospective cohort study. PLoS One 12: e0185699.
-
3.
Frijters EM, Hermans LE, Wensing AM, Devillé WL, Tempelman HA, De Wit JB, 2020. Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries. AIDS 34: 1261–1288.
-
4.
Webb S, 2018. A retrospective notes-based review of patients lost to follow-up from anti-retroviral therapy at Mulanje Mission Hospital, Malawi. Malawi Med J 30: 73–78.
-
5.
Mpinganjira S, Tchereni T, Gunda A, Mwapasa V, 2020. Factors associated with loss-to-follow-up of HIV-positive mothers and their infants enrolled in HIV care clinic: a qualitative study. BMC Public Health 20: 1–10.
-
6.
Ankunda R, Cumber SN, Atuhaire C, Kabanda T, Nkfusai CN, Wirsiy FS, Turyakira E, 2020. Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study. BMC Infect Dis 20: 1–9.
-
7.
Steinbrook E et al., 2021. Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study. BMC Pregnancy Childbirth 21: 1–11.
-
8.
Nkhonjera J, Suwedi-Kapesa LC, Kumwenda B, Nyondo-Mipando AL, 2021. Factors influencing loss to follow-up among human immunodeficiency virus exposed infants in the Early Infant Diagnosis Program in Phalombe, Malawi. Glob Pediatr Health 8: 2333794X211004166.
-
9.
Tweya H, Oboho IK, Gugsa ST, Phiri S, Rambiki E, Banda R, Mwafilaso J, Munthali C, Gupta S, Bateganya M, 2018. Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi. PLoS One 13: e0188488.
-
10.
Mancinelli S et al., 2017. Who will be lost? Identifying patients at risk of loss to follow‐up in Malawi. The DREAM Program Experience. HIV Med 18: 573–579.
-
11.
Saumu WM, Maleche-Obimbo E, Irimu G, Kumar R, Gichuhi C, Karau B, 2019. Predictors of loss to follow-up among children attending HIV clinic in a hospital in rural Kenya. Pan Afr Med J 32: 216.
-
12.
Rachlis B, Ahmad F, van Lettow M, Muula AS, Semba M, Cole DC, 2013. Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi. BMC Health Serv Res 13: 1–11.
-
13.
Birbeck GL, Molyneux ME, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, Taylor TE, 2010. Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol 9: 1173–1181.
-
14.
Postels DG, Taylor TE, Molyneux M, Mannor K, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, Birbeck GL, 2012. Neurologic outcomes in retinopathy-negative cerebral malaria survivors. Neurology 79: 1268–1272.
-
15.
Christensen SS, Eslick GD, 2015. Cerebral malaria as a risk factor for the development of epilepsy and other long-term neurological conditions: a meta-analysis. Trans R Soc Trop Med Hyg 109: 233–238.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 800 | 800 | 41 |
| Full Text Views | 97 | 97 | 8 |
| PDF Downloads | 33 | 33 | 13 |