Patterns and predictors of Abscondment from the Paediatric Wards of Four District Hospitals in Malawi

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Maziya, Madalitso D. Zulu, Christopher C. Stanley, Davie Kondowe, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8133327/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Absconding from hospital poses risks to patients. The epidemiology of absconding from hospital remains unclear in Malawi and other sub-Saharan African settings. This case-control study used data from a hospital surveillance component of the Malaria Vaccine Implementation Program in four district hospitals in Malawi to describe the patterns and determinants of absconding among paediatric patients. The cases and controls (1:1 match) were children aged 1–59 months who were hospitalized with a medical illness. Cases were children who absconded from the hospital. Controls were children admitted within ± 7 days of admission date of the corresponding cases who did not abscond, residing in the same study cluster. Baseline characteristics between cases and controls were compared using chi-squared test of independence or Fisher’s Exact test. Over the period of analysis 2.2% (454/20925) of the admitted patients absconded. Severe anemia was associated with abscondment (18.6% (53/285) vs 10.6% (32/303), p = 0.006). The hospital stay of > 3 days was more prevalent in cases of abscondment (42.2% (141/454) vs 25.4% (112/454), p = 3 days and those with severe anemia. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors absconding inpatients children Malawi Introduction Abscondment is defined as leaving a medical facility without permission and without finishing treatment [ 1 ]. Some literature suggests that 1–2% of patients leave hospitals against medical advice [ 2 ]. This behavior poses many risks to the patient, healthcare system and community [ 3 ]. The risks include prolonged recovery period, incomplete treatment with accompanied long-term medical complications, death, and increased costs for the health system and community [ 4 – 6 ]. The readmission rate for patients who abscond may be as high as 20–40%, with higher morbidity and mortality [ 7 ]. There are several reasons which have been reported in literature for abscondment. For instance, a prospective study in twelve acute admission wards from five different hospitals in the East End of London involving psychiatric patients argued that patients abscond because of boredom, threats from other patients, a feeling of being trapped and confined, having household responsibilities, feeling cut off from relatives and friends, or due to worry about security of their home and property [ 8 ]. Another study involving adults of a psychiatric in-patient ward reported that patients also abscond due to medication side effects, negative relationships with staff, and disturbance by other patients and stigma [ 9 ]. Some studies also involving psychiatric patients have investigated the characteristics of patients that abscond. Several of these studies do suggest that males are more likely to abscond than females [ 4 , 10 – 12 ]. A case-control study conducted in a general teaching hospital involving 413 patients as cases and 413 patients as controls in Shiraz, southern Iran suggested that middle aged patients are likely to abscond than other age groups [ 4 ]. Some studies have suggested that abscondment is more likely in the first days of admission than other time periods [ 13 , 14 ]. Unfortunately, there is limited data on abscondment of paediatric patients, particularly in low and middle income countries (LMICs) [ 15 ]. Most of the existing literature is from the adult population with psychiatric disorders and typically not from the LMIC setting [ 16 ]. In view of this, we analyzed the characteristics and predictors of absconding among paediatric patients in four district hospitals in Malawi. The results of this analysis will highlight categories of paediatric patients at high risk of absconding from hospital, to help health workers and systems target appropriate interventions to reduce this practice. Methods Study setting This study was conducted in four rural district hospitals (Balaka, Machinga, Mchinji and Ntchisi) in Malawi. These hospitals were part of the hospital surveillance component of the Malaria Vaccine Implementation Program (MVIP), a cluster randomized evaluation of the introduction of the RTS, S/AS01 malaria vaccine in Malawi, Kenya, and Ghana [ 17 ]. The hospital surveillance was conducted primarily to investigate incidence of cerebral malaria, and probable or confirmed meningitis among children aged 1–59 months hospitalized with an acute medical illness. Within the catchment areas of these four districts, there were seven implementing clusters and nine comparison clusters [ 17 ]. In Malawi, district hospitals are secondary facilities which serve as referral centres for the primary health facilities within their catchment areas and provide inpatient care for 80% of the country’s population [ 18 ]. Patients that cannot be managed at district hospitals are referred to central hospitals (tertiary level) [ 19 ]. These four district hospitals were selected for MVIP hospital surveillance because their catchment areas have high malaria disease burden, serve a population with a good immunisation program coverage and had basic laboratory infrastructure to support the evaluation exercise. Each hospital has an admission capacity of 200 to 300 beds [ 19 , 20 ] with approximately 40 paediatric beds. The main childhood diseases that are treated in paediatric wards of these hospitals are malaria, pneumonia and gastroenteritis. Data collection Between April 2019 and April 2020, demographic, clinical and diagnosis data were collected from all children, aged 5–48 months, hospitalized due to a medical illness. From May 2020, data collection was extended to all children aged 1 to 59 months of age. The data collection occurred up to March 2023. Data were captured directly on electronic case report forms (CRFs) in an open data kit (ODK) database via tablets. However, we did not collect data for social-economic status, access to health services, religious beliefs and other factors that could influence abscondment because MVIP evaluation was not designed to collect that information. Statistical analysis The current analyses include data from a nested case control study created within a hospital-based surveillance of MVIP. Cases were defined as children in the surveillance who absconded from hospital after spending at least a night in the hospital. Controls were defined as children who did not abscond after spending a night at the hospital, whose date of admission was ± 7 days of admission date of the corresponding cases and were coming from same geographical cluster as the cases. Cases were matched 1:1 to controls by date of admission and area of residence (cluster) as defined in MVIP surveillance program[ 17 ]. Baseline characteristics between cases and controls were compared using chi-squared test of independence or Fisher’s Exact test (as appropriate). Factors associated with abscondment were assessed by estimating odds ratios (ORs) using conditional logistic regression model. The adjusted conditional logistic model included the following covariates which were significant in the unadjusted model at the conservative alpha-level of 0.1: age of the child, primary diagnosis, length of hospital stay (< 3 days, ≥ 3 days) and presence of absence of severe anemia. Severe anemia was defined as a hemoglobin of < 5g/dL. Severe malaria anemia was defined as hemoglobin < 5 g/dL in a child with a positive malaria rapid diagnostic test. Both definitions are based on World Health Organization (WHO) blood transfusion parameter guidelines[ 21 ]. Confidence intervals (CIs) were reported as 95%, and a threshold for significance was considered at a two-sided alpha-level of 0.05. All analyses were done using Stata SE version 15.1 [ 22 ]. Ethical Considerations The MVIP evaluation received ethical approval from College of Medicine Research Ethics Committee (P.09/18/2468), University of North Carolina at Chapel Hill institutional review board (Study #: 18-3009), and WHO ethics review committee. All methods were performed in accordance with the international council for harmonization (ICH) good clinical practice guidelines. Written informed consent was obtained from legal guardians of the sub cohort children who had cerebrospinal fluid collected and stored. With approval from these ethical committees verbal consent was obtained from legal guardians of all study participants for in hospital data collection. Results Over the period of analysis, 454 patients absconded out of 20,925 patients who were admitted in all the four hospitals, giving an absconding rate of 2.2%. The absconding rate ranged from 1.7% in Balaka to 2.7% in Mchinji district hospitals. The distribution of males and females was similar between cases and controls, p = 0.5 (Table 1 ). Severe anemia was more prevalent in cases of abscondment than in controls (18.6% (53/285) vs 10.6% (32/303), p = 0.006). Hospital stay of more than three days was more prevalent in cases of abscondment than in controls (42.2% (141/454) vs 25.4% (112/454), p = < 0.001). A primary diagnosis of malaria occurred more prevalently in controls in comparison to cases (44.5% (201/454) vs 36.8% (167/454), p = 0.02). Table 1 Characteristics of childhood cases of abscondment and their controls Characteristic Cases N, (%) Controls N, (%) p-value Hospital N = 454 N = 454 Balaka 44 (9.7) 44 (9.7) 1.0 Machinga 77 (17.0) 77 (17.0) Mchinji 173 (38.1) 173 (38.1) Ntchisi 160 (35.2) 160 (35.2) Gender Female 194 (42.7) 184 (40.5) 0.5 Male 260 (57.3) 270(59.5) Age 1-11months 111 (24.5) 99 (21.8) 0.2 12–35 months 266 (58.6) 258 (56.8) 36–59 months 77 (17.0) 97 (21.4) Level of consciousness N = 288 N = 291 BCS > = 3 282 (97.9) 287 (98.6) 0.5 BCS = 90% 439 (96.7) 433 (95.4) 0.3 PO < 90% 15 (3.3) 21 (4.6) Length of Hospital Stay N = 334 N = 441 <=3 days 193 (57.8) 329 (74.6) 3 days 141 (42.2) 112 (25.4) Severe Anemia N = 285 N = 303 No 235 (82.5) 276 (91.1) 0.002 Yes 50 (17.5) 27 (8.9) Two or more convulsions N = 94 N = 76 No 17 (18.1) 13 (17.1) 0.9 Yes 77 (81.9) 63 (82.9) Primary diagnosis N = 454 N = 454 Malaria No 287 (63.2) 253 (55.7) 0.02 Yes 167 (36.8) 201 (44.3) Severe malaria 454 454 0.2 No 343 (75.6) 360 (79.3) Yes 111 (24.5) 94 (20.7) Cerebral Malaria 454 454 1 No 451 (99.3) 451 (99.3) Yes 3 (0.7) 3 (0.7) Meningitis 454 454 1 No 451 (99.3) 451 (99.3) Yes 3 (0.7) 3 (0.7) Pneumonia 454 454 No 354 (78.0) 345 (77.0) 0.5 Yes 100 (22.0) 109 (23.0) Sepsis/Septicaemia 454 454 0.3 No 390 (85.9) 400 (88.1) Yes 64 (14.1) 54 (11.9) Mosquito Bed Net use on night prior to hospitalization 454 454 0.06 No 87 (19.2) 66 (14.5) Yes 367 (80.8) 388 (85.5) Pre-existing medical conditions 454 454 0.6 No 432 (95.2) 435 (95.8) Yes 22 (4.8) 19 (4.2) Abbreviations: BCS, Blantyre Coma Score; PO= Pulse Oximetry In the unadjusted model, guardians or parents of children who were hospitalized for more than three days had significantly higher odds of absconding with their child compared to those whose children were hospitalized for three days or less (OR = 2.20; 95% confidence interval (CI): 1.55–3.13; p < 0.001) (Table 2 ). Similarly, the odds of absconding were higher among guardians or parents of children with severe anemia than among those whose children did not have severe anemia (OR = 2.00; 95% CI: 1.08–3.72; p < 0.03). In contrast, guardians or parents of children diagnosed with malaria had lower odds of absconding compared to those whose children were not diagnosed with malaria (OR = 0.70; 95% CI: 0.53–0.94; p = 0.016). Table 2 Factors associated with abscondment Variable Unadjusted Odds Ratio p-value Adjusted Odds Ratio p-value 95% CI 95% CI Age 36–59 months Ref - Ref - 12–35 months 1.30 (0.92–1.86) 0.1 1.36 (0.74–2.47) 0.3 1–11 months 1.42 (0.94–2.13 0.1 1.69 (0.82–3.46) 0.2 Gender Female Ref. - Ref - Male 0.92 (0.71–1.19) 0.5 - - Level of consciousness BCS > = 3 Ref - Ref. - BCS < 3 1.50(0.25–8.98) 0.7 - - Length of hospital stay 3 days 2.20 (1.55–3.13) = 90% Ref. - Ref - PO < 90% 0.68 (0.34–1.39) 0.3 - - LP Calculated No Ref Ref Yes 1.23 (0.87–1.74) 0.3 Severe Anemia No Ref. - Ref. - Yes 2.0 (1.08–3.72) 0.03 1.91 (0.90–4.06) 0.09 Two or more convulsions No Ref Ref Yes 2 (0.37–10.91) 0.4 Primary diagnosis Malaria No Ref. - Ref. - Yes 0.70 (0.53–0.94 0.02 0.68 (0.40–1.17) 0.2 Severe malaria No Ref. - Ref. - Yes 1.25 (0.91–1.73) 0.2 - - Cerebral Malaria No Ref Ref Yes 1 (0.20–4.95) 1 Pneumonia No Ref. - Ref. - Yes 0.89 (0.65–1.22) 0.5 - - Sepsis/Septicaemia No Ref. - Ref. - Yes 1.22 (0.82–1.81) 0.3 - - Abbreviations: BCS, Blantyre Coma Score; PO, Pulse Oximetry; LP, Lumbar Puncture Discussion In our analysis, we report the patterns and predictors of pediatric inpatient abscondment during a hospital surveillance program across four district hospitals in Malawi. The cohort comprised children with an acute medical illness in pediatric wards. We observed abscondment rate of 2.2% which is similar to some literature which indicate that 1–2% of patients abscond from hospital [ 2 ]. The abscondment rate of 2.2% is still significant because absconding from hospital is an important risk factor for poor health outcome with reported re-admission rates of 20–40%, higher morbidity and subsequent poorer clinical outcome and mortality [ 7 ]. A hospital stay of more than three days and severe anemia were associated with increased odds of absconding from hospital. Some previous studies have reported that hospital abscondment occurs early in admission. A retrospective study involving all populations in Hong Kong reported that most incidents of abscondment occurred in the first 24 hours of admission [ 13 ]. A five-year review of absconding in three acute psychiatric inpatient wards in Australia also reported patients absconding early in admission [ 14 ]. In contrast, in our current analysis, a longer hospital stay of more than three days was associated with abscondment. We believe that the longer hospital stay in pediatric wards may increase the odds for guardians of children absconding as they may become anxious and decide to seek treatment elsewhere and may also have other household responsibilities that they feel, they must attend to [ 8 ]. This may be in line with a prospective study that argued that patients may abscond because they have household responsibilities they believe they must fulfil or are worried about security of their homes and property [ 8 ]. However, it is important to note that our study is first of its kind to analyse hospital abscondment for pediatric patients with medical illness in LMICs as opposed to other studies that have focussed on adults with mental issues and in developed countries. In our analysis, children with severe anemia were at increased odds of absconding than those without. It may be that these children were also sicker warranting longer hospital stay. There might also have had some background increased socio-economic risk factors. Low socio-economic status is a known risk factor for childhood severe anemia [ 23 ]. Unfortunately, we did not collect data about social economic status as stated in the methods. Limitations The use of retrospective data is our major limitation because we could only use data that was available and information of other critical variables such as access to health services and socioeconomic status that could potentially influence abscondment were not collected. However, we assume that matching cases and controls based on location helped in ensuring that we had children coming from the same area with most likely comparable socioeconomic status and access to health services. Another possible limitation was selection bias which is common in many case control studies [ 24 ], particularly when controls are not properly selected [ 25 ]. However, we feel that we did not have selection bias in our study because our cases were carefully matched 1: 1 with controls as described. Additionally, we did not analyse the long-term outcome of abscondment in relation to mortality at home or severe medical complications that may arise due to incomplete treatment of medical illnesses. We therefore do not know the course of illness and outcome among the children that absconded. Given that among those who absconded more had severe anemia, these cases could have resulted in death and long-term sequelae from these manageable conditions. We can speculate that it is possible that those who absconded sought alternative treatment (traditional medicine, faith leaders or shops). This speculation comes in because a study that was conducted among adult cancer patients in Malawi found that prevalence of using traditional and alternative medicine was high in Malawi [ 26 ]. We suggest that future studies should include a longitudinal follow up of patients after they abscond from hospital. Lastly, in our analysis, the decision to abscond was made by a parent/caregiver of a minor patient. We therefore propose that future studies on abscondment in this setting should include qualitative studies to explore reasons for abscondment. Such studies would provide insight on the risk of abscondment in this region and how to protect minor patients who are not able to make decisions on their own. Conclusions In our analysis, there was variability in the length of hospital stay and severe anemia between cases of abscondment and their controls, with hospital stay of more man three days and presence of severe anemia having higher prevalence in absconders. Strategies to reduce pediatric inpatient abscondment in this setting should focus on children with severe anemia and those who have stayed in the hospital for more than three days. We also recommend qualitative research to investigate reasons towards patterns of abscondment noted in hospitalized children, as well as longitudinal studies to investigate their outcome. Declarations Funding Declaration The study was funded by WHO grant number HTMGMP03. Acknowledgements We would like to thank all the children and their caregivers who participated in the MVIP hospital surveillance evaluation for their willingness and consent, and the Malawi National Malaria Control Program, the Malawi MVIP hospital surveillance team, the Malawi Ministry of Health, and the staff of Balaka District Hospital, Machinga District Hospital, Mchinji District Hospital and Ntchisi District Hospital, for their support. Author contributions K.M.M. wrote the first version of the manuscript. C.C.S and H.M. performed data analysis and interpretation. D.P.M., C.C.S and T.M. were involved in conceptualization and design of this analysis. K.M., D.K., E.C. and C.M. performed data collection. T.M., J.C. and D.P.M. were involved in program management. M.D.Z. was involved in supervision of data collection. Data management and cleaning was performed by M.D.Z., C.C.S and H.M. All authors reviewed the drafts of the manuscript and approved the final version. Data availability statement All data generated or analyzed during this study are included in this published article and its supplementary information files. Competing interests The authors have no competing interests to declare. References Khammarnia, M. et al. Study of patients absconding behavior in a general hospital at southern region of Iran. Int. J. Health Policy Manag . 4 , 137–141 (2014). Gaur, A., Gilham, E., Machin, L. & Warriner, D. Discharge Against Medical Advice: The Causes, Consequences and Possible Corrective Measures. Br. J. Hosp. Med. (Lond) . 85 , 1–14 (2024). Moradpour, M., Amiresmaili, M., Nekoei-Moghadam, M. & Dehesh, T. The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study. Archives Public. Health . 79 , 106 (2021). Khammarnia, M. et al. Study of Patients Absconding Behavior in a General Hospital at Southern Region of Iran. Int. J. Health Policy Manage. 4 , 137–141 (2015). Sheikhmoonesi, F., Kabirzadeh, A., Taha Yahyavi, S. & Mohseni, B. A prospective study of patients absconding from a psychiatric hospital in Iran. Med. Glas (Zenica) . 9 , 345–349 (2012). Cullen, A. E. et al. A Prospective Cohort Study of Absconsion Incidents in Forensic Psychiatric Settings: Can We Identify Those at High-Risk? PLoS One . 10 , e0138819 (2015). Mishra, A. K. et al. Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis. J. Patient Saf. 18 , 756–759 (2022). Bowers, L., Jarrett, M., Clark, N., Kiyimba, F. & McFarlane, L. Absconding: why patients leave. J. Psychiatr Ment Health Nurs. 6 , 199–205 (1999). Falkowski, J., Watts, V., Falkowski, W. & Dean, T. Patients leaving hospital without the knowledge or permission of staff–absconding. Br. J. Psychiatry . 156 , 488–490 (1990). Mosel, K. A., Gerace, A. & Muir-Cochrane, E. Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia. Int. J. Ment Health Nurs. 19 , 177–185 (2010). Meehan, T., Morrison, P. & McDougall, S. Absconding behaviour: an exploratory investigation in an acute inpatient unit. Aust N Z. J. Psychiatry . 33 , 533–537 (1999). Anisi, S., Zarei, E., Kariman, H., Kazemi, M. & Chehrazi, M. Patient Absconding and Its Predictors: A 5-Year Retrospective Analysis in a General Teaching Hospital in Tehran, Iran. Shiraz E-Medical J. 18 , e14532 (2017). Cheng, S. T., Chung, C. H., Leung, Y. H. & Lai, K. K. Patient absconding behaviour in a public general hospital: retrospective study. Hong Kong Med. J. 8 , 87–91 (2002). Gerace, A. et al. Five-year review of absconding in three acute psychiatric inpatient wards in Australia. Int. J. Ment Health Nurs. 24 , 28–37 (2015). Muir-Cochrane, E., Mosel, K. A. & Absconding A review of the literature 1996–2008. Int. J. Ment Health Nurs. 17 , 370–378 (2008). Kaggwa, M. M., Acai, A., Rukundo, G. Z., Harms, S. & Ashaba, S. Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. BMC Psychiatry . 21 , 371 (2021). Asante, K. P. et al. Feasibility, safety, and impact of the RTS,S/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of cluster-randomised introduction of the vaccine in Ghana, Kenya, and Malawi. Lancet 403 , 1660–1670 (2024). O’Hare, B. et al. Task sharing within a managed clinical network to improve child health in Malawi. Hum. Resour. Health . 13 , 60 (2015). Makwero, M. T. Delivery of primary health care in Malawi. Afr. J. Prim. Health Care Fam Med. 10 , 1799 (2018). Malawi, M. H. Malawi Health Sector Strategic Plan 2011–2016.pdf. (2011). World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. Pocketbook of hospital care for children (World Health Organization, 2013). StataCorp Stata: Release 15 (StataCorp LLC, College Station, 2017). Islam, G. M. R. Association of Socioeconomic Status With Childhood Anemia Among Infant, Toddler, and Preschool Children in Bangladesh. Value Health Reg. Issues . 21 , 141–148 (2020). Aigner, A., Grittner, U. & Becher, H. Bias due to differential participation in case-control studies and review of available approaches for adjustment. PLoS One . 13 , e0191327 (2018). Hernán, M. A., Hernández-Díaz, S. & Robins, J. M. A structural approach to selection bias. Epidemiology 15 , 615–625 (2004). Hill, J. et al. Prevalence of Traditional, Complementary, and Alternative Medicine (TCAM) Among Adult Cancer Patients in Malawi. Cancer Causes Control . 33 , 1047–1057 (2022). Additional Declarations No competing interests reported. Supplementary Files finalabscondmentdata14Mar2025.csv finalcodeabscondmentpaper14March2025.do finalcodeabscondmentpaper14March2025.txt Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviews received at journal 23 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers invited by journal 23 Mar, 2026 Editor assigned by journal 18 Mar, 2026 Editor invited by journal 07 Dec, 2025 Submission checks completed at journal 04 Dec, 2025 First submitted to journal 04 Dec, 2025 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. 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Stanley","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"C.","lastName":"Stanley","suffix":""},{"id":610899237,"identity":"8083370d-e6af-4811-8895-2c2f678240db","order_by":3,"name":"Davie Kondowe","email":"","orcid":"","institution":"University of North Carolina Project Malawi (UNCPM)","correspondingAuthor":false,"prefix":"","firstName":"Davie","middleName":"","lastName":"Kondowe","suffix":""},{"id":610899239,"identity":"6407f983-0b0d-4e56-838e-d24ff2f2bd4d","order_by":4,"name":"Eglina Chisale","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Eglina","middleName":"","lastName":"Chisale","suffix":""},{"id":610899241,"identity":"21edcb5e-d3e6-4423-a44c-f62ac9e6e2cb","order_by":5,"name":"Chimwemwe Mateche","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Chimwemwe","middleName":"","lastName":"Mateche","suffix":""},{"id":610899242,"identity":"8405bba2-f1ac-4608-98c9-85e583451309","order_by":6,"name":"Harrison Msuku","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Harrison","middleName":"","lastName":"Msuku","suffix":""},{"id":610899243,"identity":"da32991e-044c-4204-a87b-e4251a62feef","order_by":7,"name":"Jobiba Chikhumba","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Jobiba","middleName":"","lastName":"Chikhumba","suffix":""},{"id":610899244,"identity":"c7f26368-af5e-45c3-84e4-e126016be8c8","order_by":8,"name":"Irving F. Hoffman","email":"","orcid":"","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":false,"prefix":"","firstName":"Irving","middleName":"F.","lastName":"Hoffman","suffix":""},{"id":610899246,"identity":"9323fdff-473d-430a-8740-e7abc893935e","order_by":9,"name":"Jonathan J. Juliano","email":"","orcid":"","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":false,"prefix":"","firstName":"Jonathan","middleName":"J.","lastName":"Juliano","suffix":""},{"id":610899248,"identity":"cb467d0d-38cd-4030-95c5-e18b04d7bf82","order_by":10,"name":"Don P. Mathanga","email":"","orcid":"","institution":"Kamuzu University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Don","middleName":"P.","lastName":"Mathanga","suffix":""},{"id":610899249,"identity":"0f8c98e2-1dc2-4ebe-92ce-936f54b50b83","order_by":11,"name":"Tisungane Mvalo","email":"","orcid":"","institution":"University of North Carolina Project Malawi (UNCPM)","correspondingAuthor":false,"prefix":"","firstName":"Tisungane","middleName":"","lastName":"Mvalo","suffix":""}],"badges":[],"createdAt":"2025-11-17 09:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8133327/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8133327/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105405399,"identity":"06a7f7c7-7f79-4748-80e1-ad2d909951a1","added_by":"auto","created_at":"2026-03-25 16:11:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":832854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8133327/v1/d9a0bac4-fea9-42e5-bb4d-1afcdba46ca8.pdf"},{"id":105405338,"identity":"67a70748-73a7-4cbe-a51a-058e6619fe9c","added_by":"auto","created_at":"2026-03-25 16:11:37","extension":"csv","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":388369,"visible":true,"origin":"","legend":"","description":"","filename":"finalabscondmentdata14Mar2025.csv","url":"https://assets-eu.researchsquare.com/files/rs-8133327/v1/5b51d496aecd829c705b230b.csv"},{"id":105405326,"identity":"1ddb7e8d-f1a9-47c8-a888-faac92851cc5","added_by":"auto","created_at":"2026-03-25 16:11:37","extension":"do","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1496,"visible":true,"origin":"","legend":"","description":"","filename":"finalcodeabscondmentpaper14March2025.do","url":"https://assets-eu.researchsquare.com/files/rs-8133327/v1/797ffde579b4baca6f03c339.do"},{"id":105405369,"identity":"5c2a23b7-8b34-47ae-b2a8-72cf4a1e756f","added_by":"auto","created_at":"2026-03-25 16:11:50","extension":"txt","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":1020,"visible":true,"origin":"","legend":"","description":"","filename":"finalcodeabscondmentpaper14March2025.txt","url":"https://assets-eu.researchsquare.com/files/rs-8133327/v1/a131bf8f17960cb1a51ec8dc.txt"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patterns and predictors of Abscondment from the Paediatric Wards of Four District Hospitals in Malawi","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAbscondment is defined as leaving a medical facility without permission and without finishing treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Some literature suggests that 1\u0026ndash;2% of patients leave hospitals against medical advice [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This behavior poses many risks to the patient, healthcare system and community [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The risks include prolonged recovery period, incomplete treatment with accompanied long-term medical complications, death, and increased costs for the health system and community [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The readmission rate for patients who abscond may be as high as 20\u0026ndash;40%, with higher morbidity and mortality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are several reasons which have been reported in literature for abscondment. For instance, a prospective study in twelve acute admission wards from five different hospitals in the East End of London involving psychiatric patients argued that patients abscond because of boredom, threats from other patients, a feeling of being trapped and confined, having household responsibilities, feeling cut off from relatives and friends, or due to worry about security of their home and property [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study involving adults of a psychiatric in-patient ward reported that patients also abscond due to medication side effects, negative relationships with staff, and disturbance by other patients and stigma [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome studies also involving psychiatric patients have investigated the characteristics of patients that abscond. Several of these studies do suggest that males are more likely to abscond than females [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A case-control study conducted in a general teaching hospital involving 413 patients as cases and 413 patients as controls in Shiraz, southern Iran suggested that middle aged patients are likely to abscond than other age groups [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Some studies have suggested that abscondment is more likely in the first days of admission than other time periods [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnfortunately, there is limited data on abscondment of paediatric patients, particularly in low and middle income countries (LMICs) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Most of the existing literature is from the adult population with psychiatric disorders and typically not from the LMIC setting [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In view of this, we analyzed the characteristics and predictors of absconding among paediatric patients in four district hospitals in Malawi. The results of this analysis will highlight categories of paediatric patients at high risk of absconding from hospital, to help health workers and systems target appropriate interventions to reduce this practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy setting\u003c/p\u003e \u003cp\u003eThis study was conducted in four rural district hospitals (Balaka, Machinga, Mchinji and Ntchisi) in Malawi. These hospitals were part of the hospital surveillance component of the Malaria Vaccine Implementation Program (MVIP), a cluster randomized evaluation of the introduction of the RTS, S/AS01 malaria vaccine in Malawi, Kenya, and Ghana [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The hospital surveillance was conducted primarily to investigate incidence of cerebral malaria, and probable or confirmed meningitis among children aged 1\u0026ndash;59 months hospitalized with an acute medical illness. Within the catchment areas of these four districts, there were seven implementing clusters and nine comparison clusters [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In Malawi, district hospitals are secondary facilities which serve as referral centres for the primary health facilities within their catchment areas and provide inpatient care for 80% of the country\u0026rsquo;s population [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Patients that cannot be managed at district hospitals are referred to central hospitals (tertiary level) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These four district hospitals were selected for MVIP hospital surveillance because their catchment areas have high malaria disease burden, serve a population with a good immunisation program coverage and had basic laboratory infrastructure to support the evaluation exercise. Each hospital has an admission capacity of 200 to 300 beds [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] with approximately 40 paediatric beds. The main childhood diseases that are treated in paediatric wards of these hospitals are malaria, pneumonia and gastroenteritis.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eBetween April 2019 and April 2020, demographic, clinical and diagnosis data were collected from all children, aged 5\u0026ndash;48 months, hospitalized due to a medical illness. From May 2020, data collection was extended to all children aged 1 to 59 months of age. The data collection occurred up to March 2023. Data were captured directly on electronic case report forms (CRFs) in an open data kit (ODK) database via tablets. However, we did not collect data for social-economic status, access to health services, religious beliefs and other factors that could influence abscondment because MVIP evaluation was not designed to collect that information.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe current analyses include data from a nested case control study created within a hospital-based surveillance of MVIP. Cases were defined as children in the surveillance who absconded from hospital after spending at least a night in the hospital. Controls were defined as children who did not abscond after spending a night at the hospital, whose date of admission was \u0026plusmn;\u0026thinsp;7 days of admission date of the corresponding cases and were coming from same geographical cluster as the cases. Cases were matched 1:1 to controls by date of admission and area of residence (cluster) as defined in MVIP surveillance program[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Baseline characteristics between cases and controls were compared using chi-squared test of independence or Fisher\u0026rsquo;s Exact test (as appropriate). Factors associated with abscondment were assessed by estimating odds ratios (ORs) using conditional logistic regression model. The adjusted conditional logistic model included the following covariates which were significant in the unadjusted model at the conservative alpha-level of 0.1: age of the child, primary diagnosis, length of hospital stay (\u0026lt;\u0026thinsp;3 days, \u0026ge; 3 days) and presence of absence of severe anemia. Severe anemia was defined as a hemoglobin of \u0026lt;\u0026thinsp;5g/dL. Severe malaria anemia was defined as hemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;5 g/dL in a child with a positive malaria rapid diagnostic test. Both definitions are based on World Health Organization (WHO) blood transfusion parameter guidelines[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Confidence intervals (CIs) were reported as 95%, and a threshold for significance was considered at a two-sided alpha-level of 0.05. All analyses were done using Stata SE version 15.1 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003e The MVIP evaluation received ethical approval from College of Medicine Research Ethics Committee (P.09/18/2468), University of North Carolina at Chapel Hill institutional review board (Study #: 18-3009), and WHO ethics review committee. All methods were performed in accordance with the international council for harmonization (ICH) good clinical practice guidelines. Written informed consent was obtained from legal guardians of the sub cohort children who had cerebrospinal fluid collected and stored. With approval from these ethical committees verbal consent was obtained from legal guardians of all study participants for in hospital data collection.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOver the period of analysis, 454 patients absconded out of 20,925 patients who were admitted in all the four hospitals, giving an absconding rate of 2.2%. The absconding rate ranged from 1.7% in Balaka to 2.7% in Mchinji district hospitals. The distribution of males and females was similar between cases and controls, p\u0026thinsp;=\u0026thinsp;0.5 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Severe anemia was more prevalent in cases of abscondment than in controls (18.6% (53/285) \u003cem\u003evs\u003c/em\u003e 10.6% (32/303), p\u0026thinsp;=\u0026thinsp;0.006). Hospital stay of more than three days was more prevalent in cases of abscondment than in controls (42.2% (141/454) \u003cem\u003evs\u003c/em\u003e 25.4% (112/454), p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A primary diagnosis of malaria occurred more prevalently in controls in comparison to cases (44.5% (201/454) \u003cem\u003evs\u003c/em\u003e 36.8% (167/454), p\u0026thinsp;=\u0026thinsp;0.02).\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\u003eCharacteristics of childhood cases of abscondment and their controls\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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003cp\u003eN, (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003cp\u003eN, (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;454\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalaka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMachinga\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (17.0)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMchinji\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e173 (38.1)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNtchisi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260 (57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e270(59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-11months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;35 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e258 (56.8)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;59 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;291\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCS\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287 (98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCS\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOxygen Concentration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;454\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePO\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e439 (96.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e433 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePO\u0026thinsp;\u0026lt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLength of Hospital Stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;441\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e329 (74.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSevere Anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;303\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (82.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e276 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTwo or more convulsions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;76\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (81.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrimary diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMalaria\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e287 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e253 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e201 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSevere malaria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e343 (75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e360 (79.3)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (20.7)\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\u003eCerebral Malaria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e451 (99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e451 (99.3)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0.7)\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\u003eMeningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e451 (99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e451 (99.3)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e354 (78.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345 (77.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSepsis/Septicaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e390 (85.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e400 (88.1)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMosquito Bed Net use on night prior to hospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (14.5)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e367 (80.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e388 (85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePre-existing medical conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e432 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e435 (95.8)\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e BCS, Blantyre Coma Score; PO= Pulse Oximetry\u003c/p\u003e\u003cp\u003eIn the unadjusted model, guardians or parents of children who were hospitalized for more than three days had significantly higher odds of absconding with their child compared to those whose children were hospitalized for three days or less (OR\u0026thinsp;=\u0026thinsp;2.20; 95% confidence interval (CI): 1.55\u0026ndash;3.13; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Similarly, the odds of absconding were higher among guardians or parents of children with severe anemia than among those whose children did not have severe anemia (OR\u0026thinsp;=\u0026thinsp;2.00; 95% CI: 1.08\u0026ndash;3.72; p\u0026thinsp;\u0026lt;\u0026thinsp;0.03). In contrast, guardians or parents of children diagnosed with malaria had lower odds of absconding compared to those whose children were not diagnosed with malaria (OR\u0026thinsp;=\u0026thinsp;0.70; 95% CI: 0.53\u0026ndash;0.94; p\u0026thinsp;=\u0026thinsp;0.016).\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\u003eFactors associated with abscondment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnadjusted Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;59 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;35 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30 (0.92\u0026ndash;1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.36 (0.74\u0026ndash;2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.42 (0.94\u0026ndash;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.69 (0.82\u0026ndash;3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92 (0.71\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLevel of consciousness\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCS\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCS\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.50(0.25\u0026ndash;8.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLength of hospital stay\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.20 (1.55\u0026ndash;3.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.46 (0.90\u0026ndash;2.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOxygen Saturation\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePO\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePO\u0026thinsp;\u0026lt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68 (0.34\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLP Calculated\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23 (0.87\u0026ndash;1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSevere Anemia\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0 (1.08\u0026ndash;3.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.91 (0.90\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTwo or more convulsions\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.37\u0026ndash;10.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ePrimary diagnosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMalaria\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.70 (0.53\u0026ndash;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68 (0.40\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSevere malaria\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25 (0.91\u0026ndash;1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCerebral Malaria\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.20\u0026ndash;4.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89 (0.65\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSepsis/Septicaemia\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.22 (0.82\u0026ndash;1.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: BCS, Blantyre Coma Score; PO, Pulse Oximetry; LP, Lumbar Puncture\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our analysis, we report the patterns and predictors of pediatric inpatient abscondment during a hospital surveillance program across four district hospitals in Malawi. The cohort comprised children with an acute medical illness in pediatric wards. We observed abscondment rate of 2.2% which is similar to some literature which indicate that 1\u0026ndash;2% of patients abscond from hospital [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The abscondment rate of 2.2% is still significant because absconding from hospital is an important risk factor for poor health outcome with reported re-admission rates of 20\u0026ndash;40%, higher morbidity and subsequent poorer clinical outcome and mortality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA hospital stay of more than three days and severe anemia were associated with increased odds of absconding from hospital. Some previous studies have reported that hospital abscondment occurs early in admission. A retrospective study involving all populations in Hong Kong reported that most incidents of abscondment occurred in the first 24 hours of admission [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A five-year review of absconding in three acute psychiatric inpatient wards in Australia also reported patients absconding early in admission [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In contrast, in our current analysis, a longer hospital stay of more than three days was associated with abscondment. We believe that the longer hospital stay in pediatric wards may increase the odds for guardians of children absconding as they may become anxious and decide to seek treatment elsewhere and may also have other household responsibilities that they feel, they must attend to [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This may be in line with a prospective study that argued that patients may abscond because they have household responsibilities they believe they must fulfil or are worried about security of their homes and property [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, it is important to note that our study is first of its kind to analyse hospital abscondment for pediatric patients with medical illness in LMICs as opposed to other studies that have focussed on adults with mental issues and in developed countries.\u003c/p\u003e \u003cp\u003eIn our analysis, children with severe anemia were at increased odds of absconding than those without. It may be that these children were also sicker warranting longer hospital stay. There might also have had some background increased socio-economic risk factors. Low socio-economic status is a known risk factor for childhood severe anemia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Unfortunately, we did not collect data about social economic status as stated in the methods.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThe use of retrospective data is our major limitation because we could only use data that was available and information of other critical variables such as access to health services and socioeconomic status that could potentially influence abscondment were not collected. However, we assume that matching cases and controls based on location helped in ensuring that we had children coming from the same area with most likely comparable socioeconomic status and access to health services.\u003c/p\u003e \u003cp\u003eAnother possible limitation was selection bias which is common in many case control studies [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], particularly when controls are not properly selected [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, we feel that we did not have selection bias in our study because our cases were carefully matched 1: 1 with controls as described.\u003c/p\u003e \u003cp\u003eAdditionally, we did not analyse the long-term outcome of abscondment in relation to mortality at home or severe medical complications that may arise due to incomplete treatment of medical illnesses. We therefore do not know the course of illness and outcome among the children that absconded. Given that among those who absconded more had severe anemia, these cases could have resulted in death and long-term sequelae from these manageable conditions. We can speculate that it is possible that those who absconded sought alternative treatment (traditional medicine, faith leaders or shops). This speculation comes in because a study that was conducted among adult cancer patients in Malawi found that prevalence of using traditional and alternative medicine was high in Malawi [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. We suggest that future studies should include a longitudinal follow up of patients after they abscond from hospital.\u003c/p\u003e \u003cp\u003eLastly, in our analysis, the decision to abscond was made by a parent/caregiver of a minor patient. We therefore propose that future studies on abscondment in this setting should include qualitative studies to explore reasons for abscondment. Such studies would provide insight on the risk of abscondment in this region and how to protect minor patients who are not able to make decisions on their own.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn our analysis, there was variability in the length of hospital stay and severe anemia between cases of abscondment and their controls, with hospital stay of more man three days and presence of severe anemia having higher prevalence in absconders. Strategies to reduce pediatric inpatient abscondment in this setting should focus on children with severe anemia and those who have stayed in the hospital for more than three days. We also recommend qualitative research to investigate reasons towards patterns of abscondment noted in hospitalized children, as well as longitudinal studies to investigate their outcome.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by WHO grant number HTMGMP03.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the children and their caregivers who participated in the MVIP hospital surveillance evaluation for their willingness and consent, and the Malawi National Malaria Control Program, the Malawi MVIP hospital surveillance team, the Malawi Ministry of Health, and the staff of Balaka District Hospital, Machinga District Hospital, Mchinji District Hospital and Ntchisi District Hospital, for their support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK.M.M. wrote the first version of the manuscript. C.C.S and H.M. performed data analysis and interpretation. D.P.M., C.C.S and T.M. were involved in conceptualization and design of this analysis. \u0026nbsp;K.M., D.K., E.C. and C.M. performed data collection. T.M., J.C. and D.P.M. were involved in program management. M.D.Z. was involved in supervision of data collection. Data management and cleaning was performed by M.D.Z., C.C.S and H.M. All authors reviewed the drafts of the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhammarnia, M. et al. Study of patients absconding behavior in a general hospital at southern region of Iran. \u003cem\u003eInt. J. Health Policy Manag\u003c/em\u003e. \u003cb\u003e4\u003c/b\u003e, 137\u0026ndash;141 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaur, A., Gilham, E., Machin, L. \u0026amp; Warriner, D. Discharge Against Medical Advice: The Causes, Consequences and Possible Corrective Measures. \u003cem\u003eBr. J. Hosp. Med. (Lond)\u003c/em\u003e. \u003cb\u003e85\u003c/b\u003e, 1\u0026ndash;14 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoradpour, M., Amiresmaili, M., Nekoei-Moghadam, M. \u0026amp; Dehesh, T. The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study. \u003cem\u003eArchives Public. Health\u003c/em\u003e. \u003cb\u003e79\u003c/b\u003e, 106 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhammarnia, M. et al. Study of Patients Absconding Behavior in a General Hospital at Southern Region of Iran. \u003cem\u003eInt. J. Health Policy Manage.\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e, 137\u0026ndash;141 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheikhmoonesi, F., Kabirzadeh, A., Taha Yahyavi, S. \u0026amp; Mohseni, B. A prospective study of patients absconding from a psychiatric hospital in Iran. \u003cem\u003eMed. Glas (Zenica)\u003c/em\u003e. \u003cb\u003e9\u003c/b\u003e, 345\u0026ndash;349 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCullen, A. E. et al. A Prospective Cohort Study of Absconsion Incidents in Forensic Psychiatric Settings: Can We Identify Those at High-Risk? \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e10\u003c/b\u003e, e0138819 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMishra, A. K. et al. Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis. \u003cem\u003eJ. Patient Saf.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e, 756\u0026ndash;759 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowers, L., Jarrett, M., Clark, N., Kiyimba, F. \u0026amp; McFarlane, L. Absconding: why patients leave. \u003cem\u003eJ. Psychiatr Ment Health Nurs.\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e, 199\u0026ndash;205 (1999).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalkowski, J., Watts, V., Falkowski, W. \u0026amp; Dean, T. Patients leaving hospital without the knowledge or permission of staff\u0026ndash;absconding. \u003cem\u003eBr. J. Psychiatry\u003c/em\u003e. \u003cb\u003e156\u003c/b\u003e, 488\u0026ndash;490 (1990).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMosel, K. A., Gerace, A. \u0026amp; Muir-Cochrane, E. Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia. \u003cem\u003eInt. J. Ment Health Nurs.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e, 177\u0026ndash;185 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeehan, T., Morrison, P. \u0026amp; McDougall, S. Absconding behaviour: an exploratory investigation in an acute inpatient unit. \u003cem\u003eAust N Z. J. Psychiatry\u003c/em\u003e. \u003cb\u003e33\u003c/b\u003e, 533\u0026ndash;537 (1999).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnisi, S., Zarei, E., Kariman, H., Kazemi, M. \u0026amp; Chehrazi, M. Patient Absconding and Its Predictors: A 5-Year Retrospective Analysis in a General Teaching Hospital in Tehran, Iran. \u003cem\u003eShiraz E-Medical J.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e, e14532 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng, S. T., Chung, C. H., Leung, Y. H. \u0026amp; Lai, K. K. Patient absconding behaviour in a public general hospital: retrospective study. \u003cem\u003eHong Kong Med. J.\u003c/em\u003e \u003cb\u003e8\u003c/b\u003e, 87\u0026ndash;91 (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerace, A. et al. Five-year review of absconding in three acute psychiatric inpatient wards in Australia. \u003cem\u003eInt. J. Ment Health Nurs.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e, 28\u0026ndash;37 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuir-Cochrane, E., Mosel, K. A. \u0026amp; Absconding A review of the literature 1996\u0026ndash;2008. \u003cem\u003eInt. J. Ment Health Nurs.\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e, 370\u0026ndash;378 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaggwa, M. M., Acai, A., Rukundo, G. Z., Harms, S. \u0026amp; Ashaba, S. Patients\u0026rsquo; perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. \u003cem\u003eBMC Psychiatry\u003c/em\u003e. \u003cb\u003e21\u003c/b\u003e, 371 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsante, K. P. et al. Feasibility, safety, and impact of the RTS,S/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of cluster-randomised introduction of the vaccine in Ghana, Kenya, and Malawi. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e403\u003c/b\u003e, 1660\u0026ndash;1670 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Hare, B. et al. Task sharing within a managed clinical network to improve child health in Malawi. \u003cem\u003eHum. Resour. Health\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e, 60 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakwero, M. T. Delivery of primary health care in Malawi. \u003cem\u003eAfr. J. Prim. Health Care Fam Med.\u003c/em\u003e \u003cb\u003e10\u003c/b\u003e, 1799 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalawi, M. H. Malawi Health Sector Strategic Plan 2011\u0026ndash;2016.pdf. (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cem\u003ePocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. Pocketbook of hospital care for children\u003c/em\u003e (World Health Organization, 2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStataCorp \u003cem\u003eStata: Release 15\u003c/em\u003e (StataCorp LLC, College Station, 2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIslam, G. M. R. Association of Socioeconomic Status With Childhood Anemia Among Infant, Toddler, and Preschool Children in Bangladesh. \u003cem\u003eValue Health Reg. Issues\u003c/em\u003e. \u003cb\u003e21\u003c/b\u003e, 141\u0026ndash;148 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAigner, A., Grittner, U. \u0026amp; Becher, H. Bias due to differential participation in case-control studies and review of available approaches for adjustment. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e, e0191327 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHern\u0026aacute;n, M. A., Hern\u0026aacute;ndez-D\u0026iacute;az, S. \u0026amp; Robins, J. M. A structural approach to selection bias. \u003cem\u003eEpidemiology\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e, 615\u0026ndash;625 (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHill, J. et al. Prevalence of Traditional, Complementary, and Alternative Medicine (TCAM) Among Adult Cancer Patients in Malawi. \u003cem\u003eCancer Causes Control\u003c/em\u003e. \u003cb\u003e33\u003c/b\u003e, 1047\u0026ndash;1057 (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"absconding, inpatients, children, Malawi","lastPublishedDoi":"10.21203/rs.3.rs-8133327/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8133327/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAbsconding from hospital poses risks to patients. The epidemiology of absconding from hospital remains unclear in Malawi and other sub-Saharan African settings. This case-control study used data from a hospital surveillance component of the Malaria Vaccine Implementation Program in four district hospitals in Malawi to describe the patterns and determinants of absconding among paediatric patients. The cases and controls (1:1 match) were children aged 1\u0026ndash;59 months who were hospitalized with a medical illness. Cases were children who absconded from the hospital. Controls were children admitted within \u0026plusmn;\u0026thinsp;7 days of admission date of the corresponding cases who did not abscond, residing in the same study cluster. Baseline characteristics between cases and controls were compared using chi-squared test of independence or Fisher\u0026rsquo;s Exact test. Over the period of analysis 2.2% (454/20925) of the admitted patients absconded. Severe anemia was associated with abscondment (18.6% (53/285) \u003cem\u003evs\u003c/em\u003e 10.6% (32/303), p\u0026thinsp;=\u0026thinsp;0.006). The hospital stay of \u0026gt;\u0026thinsp;3 days was more prevalent in cases of abscondment (42.2% (141/454) \u003cem\u003evs\u003c/em\u003e 25.4% (112/454), p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the setting of this analysis, strategies to reduce abscondment should target guardians whose children have stayed in the hospital for \u0026gt;\u0026thinsp;3 days and those with severe anemia.\u003c/p\u003e","manuscriptTitle":"Patterns and predictors of Abscondment from the Paediatric Wards of Four District Hospitals in Malawi","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-25 16:11:31","doi":"10.21203/rs.3.rs-8133327/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-21T08:12:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T03:32:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50155883033259096709619275394705324290","date":"2026-03-23T18:16:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T12:59:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114065905963386688476926881341186921023","date":"2026-03-23T12:46:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-23T08:09:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-18T12:14:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-08T04:56:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-04T09:51:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-04T09:28:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"729b201d-bbb0-42a0-818d-9a1ea0f8a89b","owner":[],"postedDate":"March 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":65001176,"name":"Health sciences/Diseases"},{"id":65001177,"name":"Health sciences/Health care"},{"id":65001178,"name":"Health sciences/Medical research"},{"id":65001179,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-18T16:23:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-25 16:11:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8133327","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8133327","identity":"rs-8133327","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}