Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala.
Global Health Uganda (GHU) Research Collaboration, Kampala.
Clin Infect Dis. 2020 May 23;70(11):2247-2254. doi: 10.1093/cid/ciz648.
Blackwater fever (BWF), one of the complications of severe malaria, has recently re-emerged as a cause of severe anemia (SA) in African children. However, postdischarge morbidity in children with BWF has previously not been described.
This was a descriptive cohort study in which children, aged 0-5 years, admitted to Jinja Regional Referral Hospital with acute episodes of SA (hemoglobin ≤5.0 g/dL) were followed up for 6 months after hospitalization. Incidence of readmissions or deaths during the follow-up period was compared between SA children with BWF and those without BWF.
A total of 279 children with SA including those with BWF (n = 92) and no BWF (n = 187) were followed for the duration of the study. Overall, 128 (45.9%) of the study participants were readmitted at least once while 22 (7.9%) died during the follow-up period. After adjusting for age, sex, nutritional status, and parasitemia, SA children with BWF had higher risk of readmissions (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.1-2.5) and a greater risk of death (HR. 3.37; 95% CI, 1.3-8.5) compared with those without BWF. Malaria and recurrence of SA were the most common reasons for readmissions.
There is a high rate of readmissions and deaths in the immediate 6 months after initial hospitalization among SA children in the Jinja hospital. SA children with BWF had increased risk of readmissions and deaths in the postdischarge period. Postdischarge malaria chemoprophylaxis should be considered for SA children living in malaria endemic areas.
黑水热（BWF）是严重疟疾的并发症之一，最近已重新成为非洲儿童严重贫血（SA）的一个原因。然而，以前并未描述过 BWF 患儿出院后的发病率。
这是一项描述性队列研究，研究对象为因急性 SA（血红蛋白≤5.0 g/dL）入住 Jinja 地区转诊医院的 0-5 岁儿童，在出院后进行了 6 个月的随访。比较 BWF 组和非 BWF 组 SA 患儿在随访期间的再入院率或死亡率。
共有 279 例 SA 患儿（包括 BWF 患儿[n=92]和非 BWF 患儿[n=187]）接受了研究期间的随访。总体而言，128 例（45.9%）研究参与者至少有一次再入院，22 例（7.9%）在随访期间死亡。在校正年龄、性别、营养状况和寄生虫血症后，与非 BWF 患儿相比，BWF 患儿的再入院风险更高（危险比[HR]，1.68；95%置信区间[CI]，1.1-2.5），死亡风险也更高（HR，3.37；95%CI，1.3-8.5）。疟疾和 SA 复发是再入院的最常见原因。
在 Jinja 医院，SA 患儿在首次住院后最初的 6 个月内再入院率和死亡率很高。BWF 患儿在出院后有更高的再入院和死亡风险。在疟疾流行地区，应考虑对 SA 患儿进行出院后疟疾化学预防。
