Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda, 2020–2024: a case-control study

Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda, 2020–2024: a case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda, 2020–2024: a case-control study Patrick Kwizera, Richard Migisha, Charity Mutesi, Gerald Rukundo, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7389312/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Malaria remains a major global health burden, with 264 million cases and 569,000 deaths reported in 2023. Uganda ranks third globally in malaria cases and tenth in malaria-related deaths. As of 2022, approximately 95% of the country was endemic for malaria, and children < 5 years old were most vulnerable to severe illness and mortality. Despite existing control measures, Mbale Regional Referral Hospital (MRRH) in Eastern Uganda, reported a paediatric malaria case fatality rate of 2.7% between 2020 and 2024. This study aimed to identify factors associated with malaria-related deaths among children under five admitted to the hospital during this period. Methods We conducted an unmatched 1:2 case–control study using retrospective surveillance data from MRRH for 2020–2024. Cases were children aged ≤ 59 months admitted with World Health Organization (WHO)-defined severe Plasmodium falciparum malaria who died during hospitalization (n = 100). Controls were similar children who recovered (n = 200), systematically sampled from approximately 32,400 eligible admissions. Data were abstracted from patient records. Multivariable logistic regression was performed to identify factors associated with mortality. Results Among the 100 cases, 73% were aged < 24 months, and 61% were male. Multivariable analysis showed that convulsions on admission significantly increased odds of death (adjusted odds ratio [aOR] = 17; 95% CI: 4.2–71). Loss of consciousness (aOR = 14; 95% CI: 1.4–113), severe anaemia (aOR = 3.4; 95% CI: 1.4–8.2), vomiting (aOR = 3.1; 95% CI: 1.4–6.9), and delays in seeking care over 24 hours after symptom onset (aOR = 8.8; 95% CI: 2.3–34) were also associated with increased mortality. Conclusion Malaria-related mortality among under-five children was strongly associated with neurological complications, severe anaemia, vomiting, and delayed care-seeking, while older age reduced risk. Early recognition of danger signs, timely referral, and prompt treatment especially for neurological symptoms and anaemia could reduce paediatric malaria deaths in high-burden settings like Mbale. Severe malaria Mortality Child health Risk factors Uganda Background Malaria is one of the most significant global health challenges. In 2023 alone, there were 264 million cases and 569,000 death, with the World Health Organization (WHO) African Region bearing a heavy burden. Between 2019–2023, both the number of malaria cases and deaths increased, rising by 23 million and 24,000 respectively ( 1 ). Globally, Uganda ranks as the third highest contributor to malaria cases and the tenth highest contributor to malaria-related deaths, according to the World Malaria Report (WMR) 2024 ( 1 ). As of 2022, malaria was endemic in approximately 95% of Uganda, with the remaining 5% of the country being susceptible to malaria epidemics ( 2 , 3 ). The disease accounts for 30–50% of outpatient visits,15–20% of hospital admissions and up to 20% of inpatient deaths ( 4 , 5 ). Malaria-related mortality continues to challenge Uganda’s healthcare system, especially in rural and high-burden districts where access to timely diagnosis and treatment may be limited ( 6 ). Children < 5 years of age bear the highest burden of malaria, as they are most vulnerable to severe forms of the disease and its complications. The World Health Organization (WHO) reports that this age group accounts for a significant proportion of global malaria deaths, many of which are preventable with early diagnosis and effective treatment ( 1 ). Severe malaria is defined by WHO as clinical or laboratory evidence of vital organ dysfunction, with impaired consciousness/ coma, hemoglobin levels below 7 g/dL, acute kidney injury, respiratory distress, circulatory collapse/shock, acidosis, jaundice, or disseminated intravascular coagulation ( 7 ). Without urgent intervention, these complications can lead to rapid deterioration and death, especially in young children. In Uganda, children under five represent a large proportion of malaria-related admissions and deaths ( 8 ). To address this ongoing challenge, Uganda has implemented several primary interventions for malaria control, including the distribution of insecticide-treated bed nets (ITNs) and prompt diagnosis and treatment with artemisinin-based combination therapy (ACT). Additionally, integrated community case management of childhood illnesses (iCCM) and indoor residual spraying (IRS) have been implemented in some high burden areas ( 9 ). However, despite these efforts, malaria-related mortality remains high, particularly among children under five. Between 2020 and 2024, Mbale Regional Referral Hospital (MRRH) recorded 13,903 pediatric malaria cases, of which 376 resulted in death, yielding a mortality rate of 2.7%,substantially higher than the national average of 0.6% ( 10 ).This persistently high rate suggests that additional factors may be influencing outcomes and limiting the effectiveness of existing interventions. Therefore, this study aimed to identify the key factors contributing to severe malaria-related mortality at Mbale Regional Referral Hospital, Eastern Uganda, 2020–2024. Methods Study design and study area We conducted an unmatched 1:2 case control study, utilizing routine surveillance data extracted from hospital records. It was conducted at Mbale Regional Referral Hospital. located 250 km east of Kampala, in Mbale City. The hospital serves a catchment area of over 4.6 million people across 16 districts: Budaka, Bududa, Bukwo, Bulambuli, Busia, Butaleja, Butebo, Kapchorwa, Kibuku, Kween, Manafwa, Mbale, Pallisa, Namisindwa, Sironko, and Tororo. The hospital provides both primary and specialized care, playing a crucial role in the management of a wide range of medical conditions within the area. Malaria is diagnosed mainly using microscopy and malaria rapid diagnostic test (mRDT) from peripheral blood. Malaria is classified into two categories uncomplicated, and severe forms. Uncomplicated malaria is diagnosed using rapid diagnostic tests in health facilities but also in the community by the trained village health teams (VHTs). Severe malaria cases are referred to the hospital for further management where artesunate is used as first line treatment ( 9 ). Study population The study population consisted of all children under 5 years who were admitted at Mbale Regional Referral Hospital during a 5-year period. Specifically, the focus was on children who died from malaria or related complications during this period. Case and control definitions For the purposes of this study, we defined cases and controls as follows: Case A child aged ≤ 59 months who was admitted to Mbale Regional Referral Hospital between January 2020 and December 2024 with severe Plasmodium falciparum malaria, as defined by WHO criteria, who died during hospitalization. Control A child aged ≤ 59 months who was admitted to the same hospital during the same period with severe Plasmodium falciparum malaria (WHO-defined), who survived and was discharged from the hospital. Sample size determination and sampling procedure The required sample size was estimated using the Fleiss formula with continuity correction, which is widely applied for calculating sample sizes in unmatched case–control studies comparing proportions of exposure between cases and controls ( 11 ). The calculation assumed 80% power to detect an odds ratio of 2.0 at a 5% significance level, with an expected prevalence of severe anemia among controls of 26%, based on previous studies from Rwanda ( 12 ). This yielded a target of 121 cases and 242 controls. However, since only 100 deaths due to severe malaria in children ≤ 59 months were identified at MRRH during 2020–2024, we included all these as cases and retained a 1:2 case-to-control ratio, resulting in 200 controls. The sample size was calculated using Epi Info version 7.2.6.0 (STATCAL module). Controls were selected from 32,400 under-five children admitted with laboratory-confirmed malaria who survived during the same period. Systematic sampling was employed to select 200 controls: the sampling interval (k) was calculated by dividing the total eligible controls by the desired number of controls (k = 32,400 by 200 = 162); a random starting point between 1 and k was selected, and every kth record thereafter was included until 200 controls were sampled. Data collection Data were collected using a standardized abstraction tool developed for this study and administered by two trained research assistants. After a one-day training session, the assistants retrieved patient files from physical archives. Initial demographic information such as age, sex, residence, and insurance status were obtained from hospital registers. This was followed by extraction of detailed clinical, case management, and healthcare access data from patient records, including symptoms at admission, malaria complications, treatments received (antimalarials, antibiotics, blood transfusion), duration of hospital stay, and, where applicable, timing and cause of death. Additional information on healthcare access (referral status, time to admission, mode of arrival), diagnostic testing, and environmental factors such as seasonality and admission shift was also collected. Data quality was maintained through daily reviews and cross-checking with available records. Inclusion and exclusion criteria Children aged 59 months and below with a confirmed positive malaria test (microscopy or mRDT) and presenting with severe symptoms were included in the study. We excluded children who were eligible but lacked essential information on symptoms, treatment, or outcomes, making accurate data extraction and analysis impossible outside. Data analysis procedures Descriptive statistics were used to summarize sociodemographic, clinical, and case management characteristics. Categorical variables were presented as frequencies and percentages. The Chi-squared test was used to assess associations between independent variables and the outcome variable. Logistic regression analysis was performed to identify factors associated with severe malaria-related mortality among children. Significant variables at bivariate analysis were included in the multivariable logistic regression model to calculate adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs). A p-value of < 0.05 was considered statistically significant. Data were analyzed using STATA version14 statistical software (StataCorp LLC, College Station, TX, USA). Results Socio-demographic and clinical characteristics of study participants A total of 100 case-patients and 200 control-patients were enrolled in the study. The majority of case-persons, 73 (73%) and control-persons. 130 (65%) were aged below 24 months, with fewer participants in the older age categories in both groups. The sex distribution was similar, with males comprising 61 (61%) case-persons and 106 (53%) control-persons. Case-persons were significantly more likely than control-persons to present with severe clinical features. These included convulsions (42% vs. 10%; p < 0.0001), cerebral malaria (38, 38% vs. 16, 8%; p < 0.0001), severe anaemia (35, 35% vs. 14, 7%; p < 0.0001), and vomiting (50% vs. 20%; p < 0.0001). Other significant symptoms were diarrhea (25% vs. 10%; p = 0.004), loss of consciousness (30% vs. 12%; p = 0.001), and overall danger signs (65% vs. 15%; p < 0.0001). Cases also experienced longer delays in seeking care, with fewer reaching healthcare within 12 hours of symptom onset (20% vs. 60%; p < 0.0001) and more admitted after more than four hours from symptom onset (70% vs. 40%; p < 0.001). Blood transfusions were more frequent among cases (45% vs. 20%; p = 0.001). No significant differences were observed in sex distribution, distance to hospital, or timing of admission during the week (Table 1 ). Table 1 Socio-demographic and clinical characteristics of cases and controls among children under five admitted with severe malaria at Mbale Regional Referral Hospital, Uganda, 2020–2024 Number of participants Variables Cases (%) Controls (%) P-Value Age 0.006 48 3 ( 3 ) 22 ( 11 ) Sex 0.19 Male 61 (61) 106 (53) Female 39 (39) 94 (47) Convulsion < 0.0001 Yes 62 (62) 22 ( 11 ) No 38 (38) 178 (89) Hyper parasitemia 0.79 Yes 2 ( 2 ) 5 (2.5) No 98 (98) 195 (97.5) Cerebral Malaria < 0.0001 Yes 42 (42) 3 (1.5) No 58 (58) 197 (98.5) Diarrhoea 0.004 Yes 41 (41) 50 (25) No 59 (59) 150 (75) Vomiting < 0.0001 Yes 73 (73) 96 (48) No 27 (27) 104 (52) Hypoglycaemia 0.31 Yes 4 ( 4 ) 4 ( 2 ) No 96 (96) 196 (98) Severe anaemia < 0.0001 Yes 80 (80) 99 (50) No 20 ( 20 ) 101 (50) Fever 0.47 Yes 98 (98) 193 (97) No 2 ( 2 ) 7 ( 3 ) Jaundice 0.47 Yes 2 ( 2 ) 7 ( 3 ) No 98 (98) 193 (97) Loss of consciousness 0.001 Yes 10 ( 10 ) 3 ( 1 ) No 90 (90) 197 (99) Respiratory distress 0.18 Yes 7 ( 7 ) 7 ( 4 ) No 93 (93) 193 (96) Number of severe symptoms 0.89 > 3 symptoms 11 ( 11 ) 23 ( 11 ) 4 days 16 ( 16 ) 28 ( 14 ) 1 week 82 (82) 181 (91) < 1 week 18 ( 18 ) 19 ( 9 ) Part of the week 0.67 Week day 19 ( 19 ) 34 ( 17 ) Weekend 81 (81) 166 (83) Blood transfusion 0.001 Yes 62 (62) 80 (41) No 38 (38) 115 (59) Shift on which the patient was admitted 0.06 Morning 52 (52) 111 (56) Evening 12 ( 12 ) 40 ( 20 ) Night 36 (36) 49 (24) Danger Signs < 0.0001 Yes 70 (70) 46 (23) No 30 (30) 154 (77) Time to health care < 0.0001 24hrs 17 ( 17 ) 7 (3.5) Time to hospital admission 4hrs 25 (25) 13 (6.5) Time before blood transfusion 0.9 > 3 hrs 42 (66) 53 (65) < 3hrs 22 (34) 29 (35) Distance to Hospital 0.17 10Km 39 (39) 93 (47) At multivariable analysis, several factors were significantly associated with increased odds of malaria-related mortality among under-five children with severe malaria. Convulsions on admission were strongly associated with higher odds of death (aOR = 17.2, 95% CI: 4.2–71), as was loss of consciousness (aOR = 14.0, 95% CI: 1.41–113). Children presenting with severe anaemia had over three times the odds of death compared to those without (aOR = 3.4, 95% CI: 1.41–8.17), while vomiting was also independently associated with increased mortality risk (aOR = 3.1, 95% CI: 1.39–6.94). Delays in seeking care significantly increased mortality risk - children who sought care more than 24 hours after symptom onset had markedly higher odds of death (aOR = 8.8, 95% CI: 2.3–34.3). Similarly, admission to hospital more than four hours after first contact with healthcare was associated with increased odds of death (aOR = 3.4, 95% CI: 1.25–9.2). Age categories, sex, diarrhea, blood transfusion, and overall danger signs were not significantly associated with mortality after adjustment ( Table 2 ). Table 2 Factors associated with mortality among under-five children with severe malaria, Mbale Regional Referral Hospital, Uganda 2020–2024 Number of participants Variables Cases (%) Controls (%) cOR (95%, CI aOR (95%, CI Age 48 3 ( 3 ) 22 ( 11 ) Ref Sex Male 61 (61) 106 (53) Ref Female 39 (39) 94 (47) 0.72 (0.44–1.18) 0.6 (2(0.30–1.2) Convulsion Yes 62 (62) 22 ( 11 ) 13.2 (7.2–24) 17 (4.2–71) No 38 (38) 178 (89) Ref Diarrhoea Yes 41 (41) 50 (25) 2.1 (1.3–3.5) 1.7 (0.76–3.65) No 59 (59) 150 (75) Ref Vomiting Yes 73 (73) 96 (48) 2.9 (1.73–4.93) 3.1 (1.39–6.94) No 27 (27) 104 (52) Ref Severe anaemia Yes 80 (80) 99 (50) 4.1 (2.32–7.16) 3.4 (1.41–8.17) No 20 ( 20 ) 101 (50) Ref Loss of consciousness Yes 10 ( 10 ) 3 ( 1 ) 7.3 (1.96–27.2) 14 (1.41–113) No 90 (90) 197 (99) Ref Blood transfusion Yes 62 (62) 80 (41) Ref No 38 (38) 115 (59) 2.3 (1.43–3.85) 1.1 (0.46–2.47) Danger Signs Yes 70 (70) 46 (23) 7.8 (4.5–13.4) 0.98 (0.23–4.09) No 30 (30) 154 (77) Ref Time to health care 24hrs 17 ( 17 ) 7 (3.5) 6.5 (2.6–16.5) 8.8 (2.3–34.3) Time to hospital admission 1hrs 40 (40) 88 (44) Ref 1-4hrs 35 (35) 99 (50) 0.8 (0.45–1.33) 0.64 (0.29–1.39) > 4hrs 25 (25) 13 (6.0) 4.2 (1.96–9.11) 3.4 (1.25–9.2) Ref: reference; cOR: crude odds ratios; aOR: adjusted odds ratios; CI: confidence interval Discussion This study provides insights into the factors associated with malaria-related mortality among children under five years of age at a regional referral hospital in eastern Uganda. Factors significantly associated with death in this study were convulsions, loss of consciousness or coma, severe anemia, young age, delays in health care seeking and vomiting. Neurological symptoms were strongly associated with death. Children who experienced convulsions were 17 times more likely to die than those without convulsions. This finding is consistent with earlier studies which have reported convulsions having a strong association with malaria-related mortality ( 13 , 14 ). Convulsions may signal severe cerebral involvement and should prompt urgent clinical intervention. Similarly, loss of consciousness or coma was associated with an eleven fold increased risk of death, consistent with studies from Rwanda and elsewhere highlighting altered consciousness is a critical prognostic indicator ( 8 – 10 ). These neurological signs reflect underlying disease severity and can occur even with early presentation, not just delayed care. These findings emphasize the importance of early clinical recognition and prompt management of impaired consciousness to improve survival outcomes. Severe anemia was independently associated with mortality; the odds of dying were 3.4 times among children with severe anemia compared to those without. This finding is consistent with another study from Burkina Faso ,which identified severe anemia as a major contributor to pediatric malaria mortality ( 16 ). Severe anaemia in malaria results from rapid destruction of infected and uninfected red blood cells, bone marrow suppression, and splenic sequestration, leading to tissue hypoxia, metabolic acidosis, and potentially heart failure ( 17 ).To mitigate these risks, timely measurement of haemoglobin levels and prompt access to blood transfusion are critical interventions shown to reduce mortality ( 2 ).Strengthening access to blood transfusion and timely referral can reduce fatal outcomes. The odds of death were 3.1 times higher among children who experienced vomiting, consistent with previous studies, such as one from Rwanda that linked vomiting with poorer outcomes in children under five years old ( 12 ). Vomiting may indicate more severe systemic illness or impaired oral drug absorption, which could delay effective treatment and worsen outcomes. Uncontrolled vomiting in severe malaria can contribute to hypovolemic shock and dehydration, which are potentially fatal if not promptly corrected ( 18 , 19 ). Delays in seeking care and hospital admission were critical contributors to mortality. Children who presented for care more than 24 hours after symptom onset had an eightfold increased risk of death. While hospital admission delays exceeding four hours after initial healthcare contact were associated with a near fourfold increase in mortality. These findings are consistent with other studies highlighting that delays in accessing timely care significantly elevate the odds of death ( 2 , 12 , 20 ). Overall, these findings highlight the need for early recognition of neurological symptoms, prompt referral, and timely hospital admission to improve survival. Strengthening community health systems, improving referral pathways, and training frontline healthcare workers to identify danger signs could help reduce malaria-related child mortality. Targeted interventions in rural and hard-to-reach areas may also address the heightened risk associated with delayed care. Limitations This study had some limitations: First, it was retrospective, relying on secondary data from hospital records, which may be subject to inaccuracies or incomplete documentation. This could introduce bias, especially in variables related to symptom onset and care-seeking behavior. Second, the study was also conducted at a single referral hospital, which may not fully represent the broader population of children with severe malaria in Uganda or other regions. However, the study also had notable strengths. It employed a well-defined unmatched case–control design with a sufficient sample size to detect meaningful associations. Controls were systematically sampled from a large pool of eligible patients, minimizing selection bias. Furthermore, the extended five-year study period allowed for a comprehensive assessment of severe malaria mortality trends in a high-burden, resource-limited setting, providing valuable evidence to inform targeted interventions. Conclusion This study identified convulsions, loss of consciousness, severe anemia, vomiting, and delays in care-seeking and hospital admission as key risk factors for mortality among children under five with severe malaria. These findings underscore the need for early clinical recognition of neurological signs and improved healthcare access, particularly in rural areas. Interventions aimed at strengthening triage systems, referral pathways, and community-level health education may contribute significantly to reducing malaria-related child mortality in Uganda. Abbreviations aOR: Adjusted Odds Ratio; CDC: Centers for Disease Control and Prevention; CI: Confidence Interval; cOR: Crude Odds Ratio; VHTs: Village Health Teams, ACT: Artemisinin-based Combination Therapy, ITNs: Insecticide Treated Nets, mRDT: Malaria Rapid Diagnostic Test, WMR: World Malaria Report, WHO: World Health Organization; MoH: Ministry of Health Declarations Ethics and consent to participate This study was in response to a public health emergency and was therefore determined to be non-research; it did not constitute a clinical trial, and hence a trial registration number is not applicable. The Ministry of Health (MoH) gave permission to conduct the study. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. §§See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda MoH were performed in accordance with the Declaration of Helsinki. Permission to conduct the study was also granted by Director, Mbale Regional Referral Hospital. No informed consent was required as the study utilized secondary data; however, all data were handled in accordance with established data protection protocols to ensure confidentiality and privacy. Competing interests The authors declare no competing interests Consent for publication Not applicable Availability of data and materials The datasets upon which our findings belong to the Uganda Public Health Fellowship Program. For confidentiality reasons, the datasets are not publicly available. The datasets can be availed upon reasonable request from the corresponding author with permission from the Uganda Public Health Fellowship Program. Funding and disclaimer This study was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention Cooperative Agreement number GH001353-01 through Makerere University School of Public Health to the Uganda Public Health Fellowship Program, Ministry of Health. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the US Centers for Disease Control and Prevention and the Department of Health and Human Services, Makerere University School of Public Health, or the Uganda Ministry of Health. Author contributions PK conceptualized the study idea, collected data, analyzed it, and wrote the manuscript. GR, conceptualized the study idea, and reviewed the manuscript. RM, SNK, LB, BK and ARA supported in editing, and reviewing of the manuscript. All authors read and approved the final manuscript Acknowledgments We extend our appreciation to Mbale Regional Referral Hospital administration for their overall coordination and leadership during the study and to the hospital data management team for the active participation. Lastly, we recognize the Uganda Public Health Fellowship Program for providing technical oversight, coordination, and funding throughout the study References World malaria report 2024: addressing inequity in the global malaria response. Zalwango MG, Simbwa BN, Kabami Z, Kawungezi PC, Wanyana MW, Akunzirwe R, et al. Risk factors for death among children with severe malaria, Ivukula sub-county, Namutumba district, Eastern Uganda, september 2021–february 2022. Malar J. 2024 Sep 27;23(1):288. Namuganga JF, Nankabirwa JI, Maiteki-Ssebuguzi C, Gonahasa S, Opigo J, Staedke SG, et al. East Africa International Center of Excellence for Malaria Research: Impact on Malaria Policy in Uganda. 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Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jul 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513297/ Peprah NY, Mohammed W, Adu GA, Dadzie D, Oppong S, Barikisu S, et al. Patient socio-demographics and clinical factors associated with malaria mortality: a case control study in the northern region of Ghana. Malar J. 2024 Aug 4;23(1):230. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7389312","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513480497,"identity":"ec3de2ca-bc08-4bdb-8258-66bbbef170d3","order_by":0,"name":"Patrick Kwizera","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDACHgaGAyCaH4gPMDaQokWygRQtYGAA0kiUFnOeM4YHf1Tckze+kXvwcOEOBrt+Bh7jF/i0WPb2GByQOFNsuO1GXsLhmWcYkmc28JhZ4NNicJ53wwHDtgTGbTdyDA7ztjEkGxzgMTMgqCXxX4L95hlEaznbu+HAwYaExA0SEC12QC3GD/D6pef8h4MNxxKSZ5x5Y3B4ZptEgmQzWxk+HcAQS0v++KMmwba/Pcf4c2GbjT0/e/PmD3gdhsxhZmCQSGxgZmCTIEULgz2IxmvLKBgFo2AUjDgAAAimT7nW49DnAAAAAElFTkSuQmCC","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":true,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Kwizera","suffix":""},{"id":513480498,"identity":"857dc2f1-c400-4f05-9889-bb774aa186ea","order_by":1,"name":"Richard Migisha","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Migisha","suffix":""},{"id":513480499,"identity":"81d6618c-8074-48bf-ab9a-628b03bdac1b","order_by":2,"name":"Charity Mutesi","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Charity","middleName":"","lastName":"Mutesi","suffix":""},{"id":513480500,"identity":"0bda93f2-8870-4aa2-bdd7-c27607f4da34","order_by":3,"name":"Gerald Rukundo","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Gerald","middleName":"","lastName":"Rukundo","suffix":""},{"id":513480501,"identity":"c54a4ff5-6468-42c7-8ac4-bf00782a251d","order_by":4,"name":"Steven Ndugwa Kabwama","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Steven","middleName":"Ndugwa","lastName":"Kabwama","suffix":""},{"id":513480502,"identity":"e6fea397-1b23-4059-9c42-cf790ba218bd","order_by":5,"name":"Benon Kwesiga","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Benon","middleName":"","lastName":"Kwesiga","suffix":""},{"id":513480503,"identity":"83e8b4a3-8ca6-4d1d-9f7a-90ed79a43bed","order_by":6,"name":"Lilian Bulage","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Lilian","middleName":"","lastName":"Bulage","suffix":""},{"id":513480504,"identity":"0984436f-c075-4912-af70-29defd455de0","order_by":7,"name":"Alex Riolexus Ario","email":"","orcid":"","institution":"Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Alex","middleName":"Riolexus","lastName":"Ario","suffix":""}],"badges":[],"createdAt":"2025-08-16 19:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7389312/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7389312/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95220982,"identity":"48e63d3a-95b7-43a6-9558-8b58c20961be","added_by":"auto","created_at":"2025-11-05 16:17:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1327717,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7389312/v1/fe31adf3-96af-446c-a78a-b92316cfef2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda, 2020–2024: a case-control study","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria is one of the most significant global health challenges. In 2023 alone, there were 264\u0026nbsp;million cases and 569,000 death, with the World Health Organization (WHO) African Region bearing a heavy burden. Between 2019\u0026ndash;2023, both the number of malaria cases and deaths increased, rising by 23\u0026nbsp;million and 24,000 respectively (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Globally, Uganda ranks as the third highest contributor to malaria cases and the tenth highest contributor to malaria-related deaths, according to the World Malaria Report (WMR) 2024 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs of 2022, malaria was endemic in approximately 95% of Uganda, with the remaining 5% of the country being susceptible to malaria epidemics (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The disease accounts for 30\u0026ndash;50% of outpatient visits,15\u0026ndash;20% of hospital admissions and up to 20% of inpatient deaths (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Malaria-related mortality continues to challenge Uganda\u0026rsquo;s healthcare system, especially in rural and high-burden districts where access to timely diagnosis and treatment may be limited (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eChildren\u0026thinsp;\u0026lt;\u0026thinsp;5 years of age bear the highest burden of malaria, as they are most vulnerable to severe forms of the disease and its complications. The World Health Organization (WHO) reports that this age group accounts for a significant proportion of global malaria deaths, many of which are preventable with early diagnosis and effective treatment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Severe malaria is defined by WHO as clinical or laboratory evidence of vital organ dysfunction, with impaired consciousness/ coma, hemoglobin levels below 7 g/dL, acute kidney injury, respiratory distress, circulatory collapse/shock, acidosis, jaundice, or disseminated intravascular coagulation (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Without urgent intervention, these complications can lead to rapid deterioration and death, especially in young children.\u003c/p\u003e\u003cp\u003eIn Uganda, children under five represent a large proportion of malaria-related admissions and deaths (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). To address this ongoing challenge, Uganda has implemented several primary interventions for malaria control, including the distribution of insecticide-treated bed nets (ITNs) and prompt diagnosis and treatment with artemisinin-based combination therapy (ACT). Additionally, integrated community case management of childhood illnesses (iCCM) and indoor residual spraying (IRS) have been implemented in some high burden areas (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, despite these efforts, malaria-related mortality remains high, particularly among children under five. Between 2020 and 2024, Mbale Regional Referral Hospital (MRRH) recorded 13,903 pediatric malaria cases, of which 376 resulted in death, yielding a mortality rate of 2.7%,substantially higher than the national average of 0.6% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).This persistently high rate suggests that additional factors may be influencing outcomes and limiting the effectiveness of existing interventions. Therefore, this study aimed to identify the key factors contributing to severe malaria-related mortality at Mbale Regional Referral Hospital, Eastern Uganda, 2020\u0026ndash;2024.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and study area\u003c/h2\u003e\u003cp\u003eWe conducted an unmatched 1:2 case control study, utilizing routine surveillance data extracted from hospital records. It was conducted at Mbale Regional Referral Hospital. located 250 km east of Kampala, in Mbale City. The hospital serves a catchment area of over 4.6\u0026nbsp;million people across 16 districts: Budaka, Bududa, Bukwo, Bulambuli, Busia, Butaleja, Butebo, Kapchorwa, Kibuku, Kween, Manafwa, Mbale, Pallisa, Namisindwa, Sironko, and Tororo. The hospital provides both primary and specialized care, playing a crucial role in the management of a wide range of medical conditions within the area. Malaria is diagnosed mainly using microscopy and malaria rapid diagnostic test (mRDT) from peripheral blood. Malaria is classified into two categories uncomplicated, and severe forms. Uncomplicated malaria is diagnosed using rapid diagnostic tests in health facilities but also in the community by the trained village health teams (VHTs). Severe malaria cases are referred to the hospital for further management where artesunate is used as first line treatment (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of all children under 5 years who were admitted at Mbale Regional Referral Hospital during a 5-year period. Specifically, the focus was on children who died from malaria or related complications during this period.\u003c/p\u003e\n\u003ch3\u003eCase and control definitions\u003c/h3\u003e\n\u003cp\u003eFor the purposes of this study, we defined cases and controls as follows:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003cp\u003eA child aged\u0026thinsp;\u0026le;\u0026thinsp;59 months who was admitted to Mbale Regional Referral Hospital between January 2020 and December 2024 with severe \u003cem\u003ePlasmodium falciparum\u003c/em\u003e malaria, as defined by WHO criteria, who died during hospitalization.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003cp\u003eA child aged\u0026thinsp;\u0026le;\u0026thinsp;59 months who was admitted to the same hospital during the same period with severe \u003cem\u003ePlasmodium falciparum\u003c/em\u003e malaria (WHO-defined), who survived and was discharged from the hospital.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eSample size determination and sampling procedure\u003c/h3\u003e\n\u003cp\u003eThe required sample size was estimated using the Fleiss formula with continuity correction, which is widely applied for calculating sample sizes in unmatched case\u0026ndash;control studies comparing proportions of exposure between cases and controls (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The calculation assumed 80% power to detect an odds ratio of 2.0 at a 5% significance level, with an expected prevalence of severe anemia among controls of 26%, based on previous studies from Rwanda (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This yielded a target of 121 cases and 242 controls. However, since only 100 deaths due to severe malaria in children\u0026thinsp;\u0026le;\u0026thinsp;59 months were identified at MRRH during 2020\u0026ndash;2024, we included all these as cases and retained a 1:2 case-to-control ratio, resulting in 200 controls. The sample size was calculated using Epi Info version 7.2.6.0 (STATCAL module).\u003c/p\u003e\u003cp\u003eControls were selected from 32,400 under-five children admitted with laboratory-confirmed malaria who survived during the same period. Systematic sampling was employed to select 200 controls: the sampling interval (k) was calculated by dividing the total eligible controls by the desired number of controls (k\u0026thinsp;=\u0026thinsp;32,400 by 200\u0026thinsp;=\u0026thinsp;162); a random starting point between 1 and k was selected, and every kth record thereafter was included until 200 controls were sampled.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected using a standardized abstraction tool developed for this study and administered by two trained research assistants. After a one-day training session, the assistants retrieved patient files from physical archives. Initial demographic information such as age, sex, residence, and insurance status were obtained from hospital registers. This was followed by extraction of detailed clinical, case management, and healthcare access data from patient records, including symptoms at admission, malaria complications, treatments received (antimalarials, antibiotics, blood transfusion), duration of hospital stay, and, where applicable, timing and cause of death. Additional information on healthcare access (referral status, time to admission, mode of arrival), diagnostic testing, and environmental factors such as seasonality and admission shift was also collected. Data quality was maintained through daily reviews and cross-checking with available records.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e\u003cp\u003eChildren aged 59 months and below with a confirmed positive malaria test (microscopy or mRDT) and presenting with severe symptoms were included in the study. We excluded children who were eligible but lacked essential information on symptoms, treatment, or outcomes, making accurate data extraction and analysis impossible outside.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData analysis procedures\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were used to summarize sociodemographic, clinical, and case management characteristics. Categorical variables were presented as frequencies and percentages. The Chi-squared test was used to assess associations between independent variables and the outcome variable. Logistic regression analysis was performed to identify factors associated with severe malaria-related mortality among children. Significant variables at bivariate analysis were included in the multivariable logistic regression model to calculate adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs). A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Data were analyzed using STATA version14 statistical software (StataCorp LLC, College Station, TX, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic and clinical characteristics of study participants\u003c/h2\u003e\u003cp\u003eA total of 100 case-patients and 200 control-patients were enrolled in the study. The majority of case-persons, 73 (73%) and control-persons. 130 (65%) were aged below 24 months, with fewer participants in the older age categories in both groups. The sex distribution was similar, with males comprising 61 (61%) case-persons and 106 (53%) control-persons. Case-persons were significantly more likely than control-persons to present with severe clinical features. These included convulsions (42% vs. 10%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), cerebral malaria (38, 38% vs. 16, 8%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), severe anaemia (35, 35% vs. 14, 7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and vomiting (50% vs. 20%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Other significant symptoms were diarrhea (25% vs. 10%; p\u0026thinsp;=\u0026thinsp;0.004), loss of consciousness (30% vs. 12%; p\u0026thinsp;=\u0026thinsp;0.001), and overall danger signs (65% vs. 15%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003eCases also experienced longer delays in seeking care, with fewer reaching healthcare within 12 hours of symptom onset (20% vs. 60%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and more admitted after more than four hours from symptom onset (70% vs. 40%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Blood transfusions were more frequent among cases (45% vs. 20%; p\u0026thinsp;=\u0026thinsp;0.001). No significant differences were observed in sex distribution, distance to hospital, or timing of admission during the week (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic and clinical characteristics of cases and controls among children under five admitted with severe malaria at Mbale Regional Referral Hospital, Uganda, 2020\u0026ndash;2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNumber of participants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControls (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConvulsion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e178 (89)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHyper parasitemia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e195 (97.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCerebral Malaria\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 (58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e197 (98.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiarrhoea\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150 (75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVomiting\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104 (52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypoglycaemia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.31\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e96 (96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e196 (98)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSevere anaemia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101 (50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.47\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 (97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJaundice\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.47\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 (97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLoss of consciousness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e197 (99)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRespiratory distress\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 (96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of severe symptoms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3 symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89 (89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117 (89)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of days with the illness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172 (86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDays of hospital stay\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1 week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e181 (91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1 week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePart of the week\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeekend\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e166 (83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood transfusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e115 (59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eShift on which the patient was admitted\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMorning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDanger Signs\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e154 (77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to health care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 (82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12-24hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (14.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (3.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to hospital admission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-4hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (49.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime before blood transfusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to Hospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5Km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5-10Km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10Km\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93 (47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt multivariable analysis, several factors were significantly associated with increased odds of malaria-related mortality among under-five children with severe malaria. Convulsions on admission were strongly associated with higher odds of death (aOR\u0026thinsp;=\u0026thinsp;17.2, 95% CI: 4.2\u0026ndash;71), as was loss of consciousness (aOR\u0026thinsp;=\u0026thinsp;14.0, 95% CI: 1.41\u0026ndash;113). Children presenting with severe anaemia had over three times the odds of death compared to those without (aOR\u0026thinsp;=\u0026thinsp;3.4, 95% CI: 1.41\u0026ndash;8.17), while vomiting was also independently associated with increased mortality risk (aOR\u0026thinsp;=\u0026thinsp;3.1, 95% CI: 1.39\u0026ndash;6.94). Delays in seeking care significantly increased mortality risk - children who sought care more than 24 hours after symptom onset had markedly higher odds of death (aOR\u0026thinsp;=\u0026thinsp;8.8, 95% CI: 2.3\u0026ndash;34.3). Similarly, admission to hospital more than four hours after first contact with healthcare was associated with increased odds of death (aOR\u0026thinsp;=\u0026thinsp;3.4, 95% CI: 1.25\u0026ndash;9.2). Age categories, sex, diarrhea, blood transfusion, and overall danger signs were not significantly associated with mortality after adjustment \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eFactors associated with mortality among under-five children with severe malaria, Mbale Regional Referral Hospital, Uganda 2020\u0026ndash;2024\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNumber of participants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControls (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ecOR (95%, CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eaOR (95%, CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130 (65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1 (1.19\u0026ndash;14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.8 (0.9\u0026ndash;13.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6 (0.9\u0026ndash;13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.6 (0.31\u0026ndash;8.35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.72 (0.44\u0026ndash;1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6 (2(0.30\u0026ndash;1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConvulsion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.2 (7.2\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e17 (4.2\u0026ndash;71)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e178 (89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiarrhoea\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1 (1.3\u0026ndash;3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.7 (0.76\u0026ndash;3.65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVomiting\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9 (1.73\u0026ndash;4.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.1 (1.39\u0026ndash;6.94)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSevere anaemia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1 (2.32\u0026ndash;7.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.4 (1.41\u0026ndash;8.17)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLoss of consciousness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.3 (1.96\u0026ndash;27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e14 (1.41\u0026ndash;113)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e197 (99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood transfusion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e115 (59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.3 (1.43\u0026ndash;3.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.1 (0.46\u0026ndash;2.47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDanger Signs\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.8 (4.5\u0026ndash;13.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.98 (0.23\u0026ndash;4.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e154 (77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to health care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 (82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12-24hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.1\u0026ndash;3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2 (0.85\u0026ndash;4.74)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5 (2.6\u0026ndash;16.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e8.8 (2.3\u0026ndash;34.3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to hospital admission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88 (44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-4hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.8 (0.45\u0026ndash;1.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.64 (0.29\u0026ndash;1.39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4hrs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2 (1.96\u0026ndash;9.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.4 (1.25\u0026ndash;9.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003cp\u003eRef: reference; cOR: crude odds ratios; aOR: adjusted odds ratios; CI: confidence interval\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides insights into the factors associated with malaria-related mortality among children under five years of age at a regional referral hospital in eastern Uganda. Factors significantly associated with death in this study were convulsions, loss of consciousness or coma, severe anemia, young age, delays in health care seeking and vomiting.\u003c/p\u003e\u003cp\u003eNeurological symptoms were strongly associated with death. Children who experienced convulsions were 17 times more likely to die than those without convulsions. This finding is consistent with earlier studies which have reported convulsions having a strong association with malaria-related mortality (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Convulsions may signal severe cerebral involvement and should prompt urgent clinical intervention. Similarly, loss of consciousness or coma was associated with an eleven fold increased risk of death, consistent with studies from Rwanda and elsewhere highlighting altered consciousness is a critical prognostic indicator (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These neurological signs reflect underlying disease severity and can occur even with early presentation, not just delayed care. These findings emphasize the importance of early clinical recognition and prompt management of impaired consciousness to improve survival outcomes.\u003c/p\u003e\u003cp\u003eSevere anemia was independently associated with mortality; the odds of dying were 3.4 times among children with severe anemia compared to those without. This finding is consistent with another study from Burkina Faso ,which identified severe anemia as a major contributor to pediatric malaria mortality (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Severe anaemia in malaria results from rapid destruction of infected and uninfected red blood cells, bone marrow suppression, and splenic sequestration, leading to tissue hypoxia, metabolic acidosis, and potentially heart failure (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).To mitigate these risks, timely measurement of haemoglobin levels and prompt access to blood transfusion are critical interventions shown to reduce mortality (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).Strengthening access to blood transfusion and timely referral can reduce fatal outcomes.\u003c/p\u003e\u003cp\u003eThe odds of death were 3.1 times higher among children who experienced vomiting, consistent with previous studies, such as one from Rwanda that linked vomiting with poorer outcomes in children under five years old (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Vomiting may indicate more severe systemic illness or impaired oral drug absorption, which could delay effective treatment and worsen outcomes. Uncontrolled vomiting in severe malaria can contribute to hypovolemic shock and dehydration, which are potentially fatal if not promptly corrected (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDelays in seeking care and hospital admission were critical contributors to mortality. Children who presented for care more than 24 hours after symptom onset had an eightfold increased risk of death. While hospital admission delays exceeding four hours after initial healthcare contact were associated with a near fourfold increase in mortality. These findings are consistent with other studies highlighting that delays in accessing timely care significantly elevate the odds of death (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOverall, these findings highlight the need for early recognition of neurological symptoms, prompt referral, and timely hospital admission to improve survival. Strengthening community health systems, improving referral pathways, and training frontline healthcare workers to identify danger signs could help reduce malaria-related child mortality. Targeted interventions in rural and hard-to-reach areas may also address the heightened risk associated with delayed care.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study had some limitations: First, it was retrospective, relying on secondary data from hospital records, which may be subject to inaccuracies or incomplete documentation. This could introduce bias, especially in variables related to symptom onset and care-seeking behavior. Second, the study was also conducted at a single referral hospital, which may not fully represent the broader population of children with severe malaria in Uganda or other regions. However, the study also had notable strengths. It employed a well-defined unmatched case\u0026ndash;control design with a sufficient sample size to detect meaningful associations. Controls were systematically sampled from a large pool of eligible patients, minimizing selection bias. Furthermore, the extended five-year study period allowed for a comprehensive assessment of severe malaria mortality trends in a high-burden, resource-limited setting, providing valuable evidence to inform targeted interventions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified convulsions, loss of consciousness, severe anemia, vomiting, and delays in care-seeking and hospital admission as key risk factors for mortality among children under five with severe malaria. These findings underscore the need for early clinical recognition of neurological signs and improved healthcare access, particularly in rural areas. Interventions aimed at strengthening triage systems, referral pathways, and community-level health education may contribute significantly to reducing malaria-related child mortality in Uganda.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eaOR: Adjusted Odds Ratio; CDC: Centers for Disease Control and Prevention; CI: Confidence Interval; cOR: Crude Odds Ratio; VHTs: Village Health Teams, ACT: Artemisinin-based Combination Therapy, ITNs: Insecticide Treated Nets, mRDT: Malaria Rapid Diagnostic Test, WMR: World Malaria Report, WHO: World Health Organization; MoH: Ministry of Health\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was in response to a public health emergency and was therefore determined to be non-research; it did not constitute a clinical trial, and hence a trial registration number is not applicable. The Ministry of Health (MoH) gave permission to conduct the study. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) and the Office of the Associate Director for Science, US CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). This activity was reviewed by the US CDC and was conducted consistent with applicable federal law and CDC policy. \u0026sect;\u0026sect;See, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. \u0026sect;241(d); 5 U.S.C. \u0026sect;552a; 44 U.S.C. \u0026sect;3501 et seq. All experimental protocols were approved by the US CDC human subjects review board (The National Institute for Occupational Safety and Health Institutional Review Board) and the Uganda MoH were performed in accordance with the Declaration of Helsinki. Permission to conduct the study was also granted by Director, Mbale Regional Referral Hospital. No informed consent was required as the study utilized secondary data; however, all data were handled in accordance with established data protection protocols to ensure confidentiality and privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets upon which our findings belong to the Uganda Public Health Fellowship Program. For confidentiality reasons, the datasets are not publicly available. The datasets can be availed upon reasonable request from the corresponding author with permission from the Uganda Public Health Fellowship Program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding and disclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the President\u0026rsquo;s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention Cooperative Agreement number GH001353-01 through Makerere University School of Public Health to the Uganda Public Health Fellowship Program, Ministry of Health. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the US Centers for Disease Control and Prevention and the Department of Health and Human Services, Makerere University School of Public Health, or the Uganda Ministry of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePK conceptualized the study idea, collected data, analyzed it, and wrote the manuscript. GR, conceptualized the study idea, and reviewed the manuscript. \u0026nbsp;RM, \u0026nbsp;SNK, LB, BK and ARA supported in editing, and reviewing of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our appreciation to Mbale Regional Referral Hospital administration for their overall coordination and leadership during the study and to the hospital data management team for the active participation. Lastly, we recognize the Uganda Public Health Fellowship Program for providing technical oversight, coordination, and funding throughout the study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld malaria report 2024: addressing inequity in the global malaria response. \u003c/li\u003e\n\u003cli\u003eZalwango MG, Simbwa BN, Kabami Z, Kawungezi PC, Wanyana MW, Akunzirwe R, et al. Risk factors for death among children with severe malaria, Ivukula sub-county, Namutumba district, Eastern Uganda, september 2021\u0026ndash;february 2022. Malar J. 2024 Sep 27;23(1):288. \u003c/li\u003e\n\u003cli\u003eNamuganga JF, Nankabirwa JI, Maiteki-Ssebuguzi C, Gonahasa S, Opigo J, Staedke SG, et al. East Africa International Center of Excellence for Malaria Research: Impact on Malaria Policy in Uganda. The American Journal of Tropical Medicine and Hygiene. 2022 Oct 11;107(4_Suppl):33\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eUganda [Internet]. Target Malaria. [cited 2024 Dec 17]. Available from: https://targetmalaria.org/about-us/where-we-operate/uganda/\u003c/li\u003e\n\u003cli\u003eNational Malaria Control Program [Internet]. Ministry of Health | Government of Uganda. [cited 2024 Dec 17]. Available from: https://www.health.go.ug/programs/national-malaria-control-program/\u003c/li\u003e\n\u003cli\u003eAsiimwe JB, Kadubira E. Timeliness of malaria treatment in children under five years in Uganda: an analysis of 2016 demographic health survey data. BMC Pediatrics. 2025 May 24;25(1):414. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Management of severe malaria: a practical handbook [Internet]. 3rd ed. La prise en charge du paludisme grave : guide pratique \u0026ndash; 3\u0026egrave;me ed. Geneva: World Health Organization; 2012 [cited 2025 May 4]. 83 p. Available from: https://iris.who.int/handle/10665/79317\u003c/li\u003e\n\u003cli\u003eMpimbaza A, Walemwa R, Kapisi J, Sserwanga A, Namuganga JF, Kisambira Y, et al. The age-specific incidence of hospitalized paediatric malaria in Uganda. BMC Infect Dis. 2020 Dec;20(1):503. \u003c/li\u003e\n\u003cli\u003eMinistry of Health. THE UGANDA MALARIA REDUCTION AND ELIMINATION STRATEGIC PLAN 2021-2025. \u003c/li\u003e\n\u003cli\u003ehttps://hmis.health.go.ug/dhis-web-data-visualizer/index.html#/. \u003c/li\u003e\n\u003cli\u003eStatistical Methods for Rates and Proportions | Wiley Series in Probability and Statistics [Internet]. [cited 2025 Jul 13]. Available from: https://onlinelibrary.wiley.com/doi/book/10.1002/0471445428\u003c/li\u003e\n\u003cli\u003eHategekimana JP, Simbi CMC, Ntakirutimana T, Nyirazinyoye L. Factors associated with severe malaria-related mortality among hospitalized children under five years of age in Eastern Province of Rwanda: a cross-sectional study using hospital records from 2017 to 2021. Malar J. 2024 Nov 11;23(1):340. \u003c/li\u003e\n\u003cli\u003eMutombo AM, Mukuku O, Tshibanda KN, Swana EK, Mukomena E, Ngwej DT, et al. Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo. Pan Afr Med J. 2018;29:184. \u003c/li\u003e\n\u003cli\u003evon Seidlein L, Olaosebikan R, Hendriksen ICE, Lee SJ, Adedoyin OT, Agbenyega T, et al. Predicting the Clinical Outcome of Severe Falciparum Malaria in African Children: Findings From a Large Randomized Trial. Clin Infect Dis. 2012 Apr 15;54(8):1080\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eSypniewska P, Duda JF, Locatelli I, Althaus CR, Althaus F, Genton B. Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis. BMC Medicine. 2017 Aug 3;15(1):147. \u003c/li\u003e\n\u003cli\u003eModiano: Severe malaria in Burkina Faso: influence... - Google Scholar [Internet]. [cited 2025 Jun 12]. 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Journal of Pediatric Emergency and Intensive Care Medicine [Internet]. 2017 Dec 12 [cited 2025 Jul 19]; Available from: https://caybdergi.com/articles/sudden-unexpected-death-in-a-child-with-vomiting-and-diarrhea-due-to-intracranial-mass-lesion/cayd.86570\u003c/li\u003e\n\u003cli\u003eTaghavi S, Nassar AK, Askari R. Hypovolemia and Hypovolemic Shock. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jul 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513297/\u003c/li\u003e\n\u003cli\u003ePeprah NY, Mohammed W, Adu GA, Dadzie D, Oppong S, Barikisu S, et al. Patient socio-demographics and clinical factors associated with malaria mortality: a case control study in the northern region of Ghana. Malar J. 2024 Aug 4;23(1):230. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Severe malaria, Mortality, Child health, Risk factors, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-7389312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7389312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMalaria remains a major global health burden, with 264\u0026nbsp;million cases and 569,000 deaths reported in 2023. Uganda ranks third globally in malaria cases and tenth in malaria-related deaths. As of 2022, approximately 95% of the country was endemic for malaria, and children\u0026thinsp;\u0026lt;\u0026thinsp;5 years old were most vulnerable to severe illness and mortality. Despite existing control measures, Mbale Regional Referral Hospital (MRRH) in Eastern Uganda, reported a paediatric malaria case fatality rate of 2.7% between 2020 and 2024. This study aimed to identify factors associated with malaria-related deaths among children under five admitted to the hospital during this period.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted an unmatched 1:2 case\u0026ndash;control study using retrospective surveillance data from MRRH for 2020\u0026ndash;2024. Cases were children aged\u0026thinsp;\u0026le;\u0026thinsp;59 months admitted with World Health Organization (WHO)-defined severe \u003cem\u003ePlasmodium falciparum\u003c/em\u003e malaria who died during hospitalization (n\u0026thinsp;=\u0026thinsp;100). Controls were similar children who recovered (n\u0026thinsp;=\u0026thinsp;200), systematically sampled from approximately 32,400 eligible admissions. Data were abstracted from patient records. Multivariable logistic regression was performed to identify factors associated with mortality.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the 100 cases, 73% were aged\u0026thinsp;\u0026lt;\u0026thinsp;24 months, and 61% were male. Multivariable analysis showed that convulsions on admission significantly increased odds of death (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;17; 95% CI: 4.2\u0026ndash;71). Loss of consciousness (aOR\u0026thinsp;=\u0026thinsp;14; 95% CI: 1.4\u0026ndash;113), severe anaemia (aOR\u0026thinsp;=\u0026thinsp;3.4; 95% CI: 1.4\u0026ndash;8.2), vomiting (aOR\u0026thinsp;=\u0026thinsp;3.1; 95% CI: 1.4\u0026ndash;6.9), and delays in seeking care over 24 hours after symptom onset (aOR\u0026thinsp;=\u0026thinsp;8.8; 95% CI: 2.3\u0026ndash;34) were also associated with increased mortality.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMalaria-related mortality among under-five children was strongly associated with neurological complications, severe anaemia, vomiting, and delayed care-seeking, while older age reduced risk. Early recognition of danger signs, timely referral, and prompt treatment especially for neurological symptoms and anaemia could reduce paediatric malaria deaths in high-burden settings like Mbale.\u003c/p\u003e","manuscriptTitle":"Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda, 2020–2024: a case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-15 08:30:35","doi":"10.21203/rs.3.rs-7389312/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09ae24ce-8fcf-4724-9c11-d3e0ec54060d","owner":[],"postedDate":"September 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T10:24:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-15 08:30:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7389312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7389312","identity":"rs-7389312","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}