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Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case–Control Study

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  • 1 Child Health & Development Centre, Makerere University-College of Health Sciences, Kampala, Uganda;
  • | 2 Department of Pediatrics & Child Health, Makerere University-College of Health Sciences, Kampala, Uganda;
  • | 3 Department of Medicine, University of California, San Francisco, California;
  • | 4 Clinical Epidemiology Unit, Department of Medicine, Makerere University-College of Health Sciences, Kampala, Uganda
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We studied associations between delayed care seeking, demographic, socioeconomic, and geographic factors and likelihood of severe malaria in Ugandan children. The study was based at Jinja Hospital, Uganda. We enrolled 325 severe malaria cases and 325 uncomplicated malaria controls matched by age and residence. Patient details, an itinerary of events in response to illness, household information, and location of participants’ residences were captured. Conditional logistic regression was used to determine risk factors for severe malaria and delayed care seeking. Delayed care seeking (≥ 24 hours after fever onset; odds ratio [OR] 5.50; 95% confidence interval [CI] 2.70, 11.1), seeking care at a drug shop as the initial response to illness (OR 3.62; 95% CI 1.86, 7.03), and increasing distance from place of residence to the nearest health center (OR 1.45; 95% CI 1.17, 1.79) were independent risk factors for severe malaria. On subgroup analysis, delayed care seeking was a significant risk factor in children with severe malaria attributable to severe anemia (OR 15.6; 95% CI 3.02, 80.6), but not unconsciousness (OR 1.13; 95% CI 0.30, 4.28). Seeking care at a drug shop (OR 2.84; 95% CI 1.12, 7.21) and increasing distance to the nearest health center (OR 1.18; 95% CI 1.01, 1.37) were independent risk factors for delayed care seeking. Delayed care seeking and seeking care at a drug shop were risk factors for severe malaria. Seeking care at a drug shop was also a predictor of delayed care seeking. The role of drug shops in contributing to delayed care and risk of severe malaria requires further study.

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Author Notes

Address correspondence to Arthur Mpimbaza, Child Health & Development Centre, Makerere University-College of Health Sciences, P.O. Box 6717, Kampala, Uganda. E-mail: arthurwakg@yahoo.com

Financial support: This research was supported by two training awards from the NIH Fogarty International Center, the University of California Global Health Institute GloCal Health Fellowship (TW009343) and the Training in Malaria Research in Uganda program (TW007375). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors’ addresses: Arthur Mpimbaza, Grace Ndeezi, Anne Katahoire, and Charles Karamagi, College of Health Sciences, Makerere University, Kampala, Uganda, E-mails: arthurwakg@yahoo.com, gndeezi@gmail.com, annekatahoire@yahoo.co.uk, and ckaramagi2000@yahoo.com. Philip J. Rosenthal, University of California, San Francisco, CA, Email: philip.rosenthal@ucsf.edu.

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