Characteristics Linked to Severe Malaria in Under Five Years Old Children at Hoima Regional Referral Hospital, Hoima District

Logiel Deogratias Emuron

Faculty of Clinical Medicine Kampala International University Western Campus Uganda.


This research aimed to identify the factors associated with severe malaria in children below five years old at Hoima Regional Referral Hospital in Hoima District. The study employed a cross-sectional approach, gathering both qualitative and quantitative data via participant self-administered and investigator-administered questionnaires. A sample of 384 children, aged 6 months to 4 years, participated using convenience sampling. The findings, presented with 95% Confidence Intervals (C.I), Odds Ratios (OR), and P-values, were calculated using Binary Logistic Regression with Pearson’s correlation in Statistical Package for Social Sciences (SPSS) Version 26. Visual representation utilized Microsoft Excel Software. The study had a response rate of 91.4%, encompassing 351 respondents, among whom 153 (43.6%) were male and 198 (56.4%) were female. The mean age was 2 years (with a standard deviation of 1.25 years). The malaria prevalence among these children attending HRRH was 27.4%. This prevalence was significantly linked to several factors: health service-seeking behavior, caretaker’s education level, mosquito net usage, child’s age, and caretaker’s occupation, all exhibiting considerable influence on malaria in children under five. Pearson’s correlation indicated the significance of these variables: health service-seeking behavior (0.139*, P=0.021), mosquito net use (0.286*, P=0.000), and health service-seeking behavior (0.131*, P=0.021) with a 2-tailed test at a 95% confidence level, P<0.05. The high prevalence of malaria (27.4%) among children attending HRRH in Hoima District is notably affected by health service-seeking behavior, mosquito net usage, caretaker’s education, caretaker’s occupation, and the child’s age.

Keywords: Malaria, children less than 5 years, Mosquito, Caretaker, Health service-seeking behaviour.


Malaria was among the world’s most common and life-threatening tropical diseases. Malaria was caused by Plasmodium parasites which are transmitted through the female Anopheles mosquito’s bite which occurs mainly between dusk and dawn [1–3]. In humans, malaria is caused by 4 parasites namely; Plasmodium falciparum, Plasmodium vivax, Plasmodium malaria and Plasmodium ovale. P. falciparum and P. vivax are the commonest [4-6], however, P. falciparum remains the single most important threat to public health at a global scale since it is the most deadly. It accounts for more than 90% of the world’s malaria mortality, [7–9]. Malaria is endemic in most tropical regions and about 3.4 billion people worldwide are exposed to malaria annually and 1.2 billion are at high risk, [9, 10]. Although preventable and curable, malaria causes significant morbidity and mortality especially in regions with limited resources[11]. An estimated 300-500 million people suffer from malaria every year and 1.5-2.7 million deaths occur, [12]. Sub-Saharan Africa is the most affected region contributing over 80% of global malaria deaths [6]. Although half of the world’s population is at risk of malaria, and whilst anyone living or visiting a malaria endemic area may be at risk, vulnerability is higher in certain groups, particularly pregnant women and children. Malaria was a leading cause of death among children less than 5 years, who represent 77% of all global malaria deaths [7, 8, 13]. In Africa a child dies every minute from malaria [1]. Children are mostly affected because their immune systems are not yet fully developed to fight severe forms of disease. Severe malaria occurs due to delayed treatment of uncomplicated malaria. This stage of disease is defined by the presence of clinical and laboratory evidence of vital organ dysfunction. Almost all death from malaria result from infection with plasmodium falciparum[14] Malaria is easily preventable, curable and treatable , it’s still  a big health threat and a leading cause of morbidity and mortality to many communities world over most especially in Sub-Saharan Africa. Although there has been advances in terms of new drugs and vaccines, eradication is still a way off and many health strategies now focus on malaria prevention and control [15]. Malaria is a serious disease that’s caused by a parasite that is spread by a certain type of mosquito which feeds on humans. People who get malaria are typically very sick. The bulk of the malaria disease burden is concentrated in sub-Saharan Africa, and in this area nearly all malaria is caused by plasmodium falciparum. Efforts to reduce the burden of malaria have intensified recently through the use of effective tools for malaria like intermittent Preventive Treatment for pregnant mothers, distribution of Long Lasting Insecticide Treated nets the communities, early diagnosis and treatment [16]. Efforts to reduce the burden of malaria have intensified recently through the use of effective tools for malaria like intermittent Preventive Treatment for pregnant mothers, distribution of Long Lasting Insecticide Treated nets the communities, early diagnosis and treatment [16]Uganda has the third highest number of P. falciparum infections in sub-Saharan Africa, and some of the highest reported malaria transmission rates in the world.

Malaria is a major public health concern in the world and more especially among the children because of their vulnerability .as such, malaria has been described as an entrenched global health challenge [17], the disease is endemic in over hundred countries in the world. Approximately half of the world’s population is at risk of malaria and nearly one million people die of the disease each year [18]. In 2016, it was estimated that 216 million cases of malaria occurred worldwide and 445000 deaths occurred from malaria globally. The WHO African region had most cases that is 90% followed by the WHO south east ASIA region 7% and the WHO eastern Mediterranean region 2%, on the same note it was estimated that in 2016 most deaths 91% were in the WHO African region [14]. Two-thirds of malaria cases in 2016 were children under the age of five years and most of these deaths occurred in sub-Saharan Africa. Since 2010 mortality rates among children under 5 years have fallen by 34% [19]. Malaria is endemic in over 95% of Uganda (ministry of health 2014).  Statistics from the Ministry of Health show that malaria is still the leading cause of death in Uganda, accounting for over 27% of deaths. The statistics also show that Uganda has the world’s highest malaria incidence, with a rate of 478 cases per 1,000 Population per year. Uganda ranks 6th among African countries with high malaria-related mortality rates. In Uganda malaria remains the most important disease causing significant morbidity, mortality and negative socio-economic impact. Children under five are at high risk because of their low immunity against the disease. Hospital records suggest that malaria accounts for 30-50 percent of outpatient visits, 15-20 percent of admissions and 19-14 percent inpatient deaths[8] The mortality due to severe malaria in under-fives usually exceeds 10% and increases with age. Several predictive factors for death in severe childhood malaria have been identified, among them, coma, convulsions, acidosis, respiratory distress, hypoglycemia, retinal changes, increased concentration of lactate in blood and cerebral spinal fluid and increased concentration of tumour necrosis factor[20]. Many interventions have been made by the internal community the Ministry of Health and health services to ensure that all people at risk receive appropriate preventive measures, diagnostics and treatment, there are still several children under five who suffer the severe forms of malaria most especially those in Hoima regional referral hospital. This study aimed to determine factors associated with severe malaria in children under the age of five at Hoima Regional Referral Hospital in Hoima District.


Prevalence of Malaria in children attending HRRH, Hoima District is high (27.4%). This prevalence is influenced by factors including health service seeking behavior, mosquito net use habits, caretaker’s education, caretaker’s occupation and child’s age.


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CITE AS: Logiel Deogratias Emuron (2023). Characteristics Linked to Severe Malaria in Under Five Years Old Children at Hoima Regional Referral Hospital, Hoima District. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 8(3): 71-86.