Jumi Loro Gore Lado, Mohmmed Altaiyb Omer Ahmed
Department of Statistics and Demography, School of Social and Economic Studies, University of Juba, Juba, SSD.
Department of Statistics, College of Science, Sudan University of Science and Technology, Khartoum, SDN.
Cureus. 2025 Feb 15;17(2):e79074. doi: 10.7759/cureus.79074. eCollection 2025 Feb.
Malaria remains one of the major health problems worldwide. It is a leading cause of morbidity and mortality in South Sudan, especially in children. The aim of this study was to estimate the survival functions of children with malaria and to compare these functions with respect to the associated factors.
This was a retrospective cohort study that utilized data extracted from records of children aged 1 month to 15 years who were diagnosed with malaria and admitted to Al Sabah Children's Hospital, Juba, South Sudan from 1 January to 31 December 2021. Kaplan-Meier was employed to estimate the survival functions, and the log-rank test statistic was used to compare survival curves with respect to categories of specific covariates.
Out of 6,410 children diagnosed with malaria who were included in this study, 3,595 (56.08%) were males and 2815 (43.92%) were females. A total of 303 (4.73%) died and 6,107 (95.27%) were censored. The median survival time was three days (IQR 2-4), and the mean age of the study cohort was 23.66 months (95% CI: 23.01 to 24.32). Comorbidity status among children indicated that 1,552 (24.01%) had comorbidities during admission. With respect to the treatment covariate, 3,920 (61.15%) were treated with artesunate. Kaplan-Meier survival curves showed increased survival for children treated with quinine and those without comorbidity. The log-rank test revealed that the covariates treatment and comorbidity were significant (p < 0.05), both having an impact on survival among children.
This study found that the median survival time for children with malaria was three days. Additionally, comorbidity decreased survival among children. Treatment with quinine showed better survival rates compared to artesunate, despite studies suggesting artesunate as a replacement for quinine. Strengthening the healthcare system, provision of good-quality drugs, and implementing control intervention measures to reduce the transmission of malaria are essential for improving child survival in the country. Furthermore, it is essential to carry out a comparative study of quinine and artesunate for the treatment of malaria. Future studies on malaria in South Sudan have to be conducted by using a prospective study design to address the challenges of incomplete data and potential biases.
疟疾仍然是全球主要的健康问题之一。它是南苏丹发病和死亡的主要原因，尤其是在儿童中。本研究的目的是估计疟疾患儿的生存函数，并比较这些函数与相关因素。
这是一项回顾性队列研究，利用从2021年1月1日至12月31日在南苏丹朱巴的萨巴赫儿童医院被诊断为疟疾并入院的1个月至15岁儿童的记录中提取的数据。采用Kaplan-Meier法估计生存函数，并使用对数秩检验统计量比较特定协变量类别下的生存曲线。
本研究纳入的6410名诊断为疟疾的儿童中，3595名（56.08%）为男性，2815名（43.92%）为女性。共有303名（4.73%）死亡，6107名（95.27%）被截尾。中位生存时间为3天（四分位间距2 - 4），研究队列的平均年龄为23.66个月（95%置信区间：23.01至24.32）。儿童的合并症状况表明，1552名（24.01%）在入院时有合并症。关于治疗协变量，3920名（61.15%）接受了青蒿琥酯治疗。Kaplan-Meier生存曲线显示，接受奎宁治疗的儿童和无合并症的儿童生存率增加。对数秩检验显示，协变量治疗和合并症具有显著性（p < 0.05），两者均对儿童生存有影响。
本研究发现，疟疾患儿的中位生存时间为3天。此外，合并症降低了儿童的生存率。尽管有研究建议用青蒿琥酯替代奎宁，但奎宁治疗的生存率高于青蒿琥酯。加强医疗保健系统、提供优质药物以及实施控制干预措施以减少疟疾传播对于提高该国儿童生存率至关重要。此外，对奎宁和青蒿琥酯治疗疟疾进行比较研究至关重要。未来关于南苏丹疟疾的研究必须采用前瞻性研究设计，以应对数据不完整和潜在偏差的挑战。
