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IAA Journal of Biological Sciences 12(2):25-38, 2024 www.iaajournals.org
©IAAJOURNALS ISSN:2636-7254
https://doi.org/10.59298/IAAJB/2024/122.253811 IAAJB:122.253811

Risk factors associated with severe malaria in

children under five years of age at Jinja Regional
Referral Hospital, Uganda.
Henry Sosolyo
Department of Medicine and Surgery, Kampala International University, Western Campus, Uganda

ABSTRACT
Malaria is among the world's most common and life-threatening tropical diseases. Malaria is caused by
Plasmodium parasites, which are transmitted through the female Anopheles mosquito's bite, which occurs mainly
between dusk and dawn. Children are mostly affected because their immune systems are not yet fully developed to
fight severe forms of disease. This study determined risk factors associated with severe malaria in children under
five years in the Jinja regional referral hospital in Jinja City, Eastern Uganda. A prospective cross-sectional study
was conducted on 380 participants to determine factors associated with severe malaria among children under five
years. After completing data collection, the data was subsequently fed into Statistical Package for the Social
Sciences (SPSS) version 20 for analysis. In a tabular form, each independent variable was analyzed in a univariate
form; the independent variables were compared with the dependent variable in a bivariate form, then subsequently
multivariate, and this served as the basis for drawing conclusions in this study. Among the 380 participants in the
study, the majority (57.6%) were above 3 years old, had household heads aged 26–40 years old (56.6%), and were
male (65.3%). This study found that among the socio-demographic factors, age of the child, education level of the
caregiver, and marital status of the caregiver were significantly associated with severe malaria among children
under five years. Further, type of toilet facility used at home, size of household, having a treated mosquito net and
using it, and number of children under five years in the household were significantly associated with severe
malaria among children under five years. This study further established an association between distance to the
health facility, waiting hours, getting all medication while at the facility, and severe malaria among children under
five years. Severe malaria among children under five years old is still a big public health challenge. Factors
associated with severe malaria among children under five years include age of the child, education level of
caregiver, marital status of caregiver, type of toilet facility used at home, size of household, owning a treated
mosquito net, number of children under five, distance to the health facility, waiting hours, and getting all
medication while at the health facility.
Keywords: Risk, severe malaria, children, Jinja, regional, referral hospital, Uganda.

INTRODUCTION
The female Anopheles mosquito bite is the primary which is defined by the presence of clinical and
method of transmission for the common and laboratory evidence of vital organ dysfunction[7].
potentially fatal tropical disease known as malaria[1, Efforts to reduce the burden of malaria have
2]. It affects about 3.4 billion people worldwide intensified recently through the use of effective tools
annually, with 1.2 billion at high risk. Although like intermittent preventive treatment for pregnant
preventable and curable, malaria causes significant mothers, the distribution of long-lasting insecticide-
morbidity and mortality, especially in regions with treated nets, and early diagnosis and treatment.
limited resources. Sub-Saharan Africa is the most Uganda has the third-highest number of P.
affected region, contributing over 80% of global falciparum infections in sub-Saharan Africa and
malaria deaths [3–5]. Vulnerability is higher in some of the highest reported malaria transmission
certain groups, particularly pregnant women and rates in the world. In 2015, malaria accounted for
children [6]. Children less than 5 years old 34% of outpatient visits and 28% of hospital
represent 77% of all global malaria deaths, and their admissions. Hospital admissions decreased by two
immune systems are not yet fully developed to fight percentage points in 2015, while laboratory-
severe forms of the disease. Severe malaria occurs confirmed cases increased by 16 percentage points
due to delayed treatment of uncomplicated malaria, [4].
25
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Malaria, an ancient disease originating from the deaths occur in sub-Saharan Africa, and 70% are of
Italian word "mal-aria" or "bad air," has been the children under the age of five years old. However,
subject of numerous theories since its discovery in malaria remains a major cause of morbidity in
1898 [8, 9]. The disease is primarily prevalent in children in sub-Saharan Africa, with 10% of the
tropical and subtropical regions, particularly in sub- deaths of children under the age of five due to
Saharan Africa, but also in other tropical regions of malaria. Uganda ranks third in the total number of
China, India, Southeast Asia, and South and Central malaria cases in sub-Saharan Africa, and its weather
America. Malaria has been a widespread and conditions often allow transmission to occur all year
potentially lethal human infectious disease, infesting round. Climates affect both the parasite and the
every continent except Antarctica. Prevention and mosquito, making it a complex and multifaceted
treatment have been targeted in science and issue [9]. Malaria is the leading cause of morbidity
medicine for hundreds of years. Research attention in Uganda, with 90% of the population at risk and
has focused on the biology of the parasites and the 13% of underfive mortality. Children under the age
mosquitoes that transmit the parasites. Human of 5 are among the most vulnerable to malaria
behavior and living standards have been critical infection, as they have not developed any immunity
factors in the spread or eradication of the disease. to the disease. The malaria control program (MCP)
Poverty has been and remains associated with the was established in 1995 to guide the day-to-day
disease [10]. Traditional herbal remedies have been implementation of the National Malaria Control
used to treat malaria for thousands of years, with the Strategy [13]. Today, the fight against malaria is
first effective treatment coming from the bark of the part of the overall effort of the government of
cinchona tree, which contains quinine. There are Uganda, with the support of several partners, to
several theories proposed about malaria, including improve health with the overall goal of reducing
the themiasma theory, which suggests diseases were mortality due to malaria by 80% of the 2010 levels
caused by the presence of miasma, a poisonous vapor and morbidity due to malaria by 75% of the 2010
filled with suspended particles of decaying matter levels by 2020. Nationally representative cross-
characterized by its foul smell. This theory sectional surveys are carried out in the country to
originated in the Middle Ages and endured for monitor and evaluate the progress of malaria
several centuries. In contrast to the long-held control. The goal of the study is to identify risk
medical belief that malaria was a result of poor air factors, household and sociodemographic variables,
quality, the mosquito malaria theory, which emerged and health-related variables linked to severe malaria
in the latter half of the 19th century, proposed that in children under five years old at Jinja Regional
mosquitoes were the primary vectors of the disease Referral Hospital, Uganda. It also aims to
[11, 12]. Malaria is considered one of the main investigate the relationship between these variables
global health problems, causing approximately and the severity of the disease in these young
438,000 deaths in 2015. Ninety percent of these patients.
METHODOLOGY
Study Design Buikwe District to the northwest, Kamuli District to
A prospective cross-sectional study was conducted the east, Kayumga District to the southeast, Buvuma
to determine the association between socio- District to the southeast, and Lake Victoria to the
demographic factors and household factors. Health north. JRRH is a public hospital funded by the
system factors, and severe malaria in children less Uganda Ministry of Health, and general care in the
than five years of age admitted to the pediatric ward hospital is free. It is one of the 16 regional referral
in Jinja regional referral hospital (JRRH). Structured hospitals in Uganda, and it is designated as one of
questionnaires were used to collect data from the the 35 internship hospitals.
caretakers of the patients. Caregivers of children Study population
with severe malaria were contacted while their The study population was children less than five
children were on admission. years old who were admitted to the pediatric ward
Study Area due to severe malaria during the study period with
The study was conducted in Jinja Regional Referral their caregivers.
Hospital (JRRH), which is located about 145km west Inclusion Criteria
of Malale, the largest city in the Eastern Region (2i). A child below 5 years old with a primary diagnosis
This is approximately 99km (135 mi) by road east of of WHO-defined severe malaria was admitted to the
Kampala Uganda, the largest and capital city on all pediatric ward of Jinja regional referral hospital.
tarmac two-lane highway 3i. Jinja City is the main Caregiver who consented to participate in the study
town of Busoga Kingdom in Jinja District. The
district is bordered by Mayuge District to the east,
26
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Exclusion Criteria administered by trained research assistants,
A child admitted to the pediatric ward but for other providing exhaustive options for responses. The
disease conditions other than severe malaria study aimed to understand the impact of healthcare
Caretakers who declined consent for participation in on caregivers and their children.
the study Data Analysis
Sample Size Determination After complete data collection, the data was
The sample size was determined using the Kish- subsequently fed into SPSS version 20 for analysis.
Leslie [14] formula: In a tabular form each independent variable was
n = z²p (1-p) / E²; analyzed in a univariate form, the independent
Where; variables was compared with the dependent variable
n = Estimated minimum sample size required in a bivariate form then subsequently multivariate
P= Proportion of 55% prevalence of severe malaria and this served as the basis for making
in children less than five years. conclusionin this study.
Z=1.96 (for 95% Confidence Interval) Quality control measures
e = Margin of error set at 5% Selected Research Assistants were trained on the
study protocol, questionnaire, informed consent
n = 1.962 x 0.55(1 – 0.55) process and other study procedures. Completed
0.052 questionnaires were checked on daily basis for
n = 380 accuracy, consistency and completeness.
Ethical consideration
Sampling Procedure Ethical approval was obtained from KIU IREC
Simple random sampling method was used to get (International Research and Development
respondents to avoid bias. Small pieces of papers Conference) and JRRH. Study proposal was
were written on number from 1 to 10 and whoever presented to department of Pediatrics in JRRH for
picked an even number and consented was enrolled review and approval. Written informed consent was
into the study. obtained from the participants. Participants were
Data Collection method given an opportunity to ask questions about the
This study involved interviewing caregivers of study and the investigator responded. Participants
children with severe malaria using structured were free to decline from participating or withdraw
questionnaires. The questionnaires were open and consent at any time during the study. Confidentiality
closed-ended, collecting data on caregivers and their of the participant’s information was maintained by
children's demographic factors, health system, and using unique reference codes during the data
household factors. The interviews were conducted collection and analysis. Permission was obtained
on the day of admission or the next day after the from the administration of Jinja regional referral
child's condition stabilized. The questionnaires were Hospital before starting the study.
RESULTS
Socio-demographic characteristics Majority of the caregivers (67.1%) were farmers,
Among the 380 participants in the study, majority 46.8% attained secondary education and were
(57.6%) were above 3 years, had household heads married (86.3%) as shown in the table below.
aged 26-40years (56.6%) and were male (65.3%).

27
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Table 1: Socio-demographic characteristics
Variable Frequency(N=380) Percentage (%)
Age of the child
≤2years 161 42.4
≥3years 219 57.6
Age of the household head
≤25years 97 25.5
26-40years 215 56.6
≥41years 68 17.9
Sex of the child
Male 248 65.3
Female 132 34.7
Occupation of caregiver
Farmer 255 67.1
Non-farmer 125 32.9
Educational level of the caregiver
None 27 7.1
Primary 83 21.8
Secondary 178 46.8
Tertiary 92 24.2
Marital status of the caregiver

Married 328 86.3

Single 52 13.7

Bivariate analysis of socio-demographic factors caregiver and marital status of caregiver were
associated with severe malaria in children under significant with p-values less than 0.2 and were
five years. therefore considered for multivariate analysis as
At Bivariate analysis, age of the child, sex of the shown in the table below.
child, occupation of the caregiver, education level of
Table 2: Bivariate analysis of socio-demographic factors associated with severe malaria among children
under five years
Variable N=380 Severe cOR (95% CI) P-Value
malaria
n (%)
Age of the child
≤2years 161 17(10.6) 1.50(0.84-3.60) 0.021
≥3years 219 14(6.4) Reference
Age of the household head
≤25years 97 15(15.5) 2.41(1.00-4.82) 0.280
26-40years 215 07(3.3) 1.32(0.09-2.01) 0.312
≥41years 68 09(13.2) Reference
Sex of the child
Male 248 22(8.9) 2.30(1.22-5.00) 0.019
Female 132 09(6.8) Reference
Occupation of caregiver
Farmer 255 24(9.4) 3.04(1.99-6.78) 0.152
Non-farmer 125 07(5.6) Reference
Educational level of the caregiver
None 27 09(33.3) 2.09(1.22-4.55) 0.038
Primary 83 12(14.5) 1.63(1.01-2.87) 0.410
Secondary 178 08(4.5) 1.17(0.72-2.10) 0.826
Tertiary 92 02(2.2) Reference
Marital status of the caregiver
Married 328 18(5.5) Reference
Single 52 13(25.0) 1.00(0.08-2.40) 0.001

28
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Multivariate analysis of socio-demographic From the table below, age of the child, education
factors associated with severe malaria in children level of the caregiver and marital status of the
under five. caregiver were significantly associated with severe
malaria among children under five years.
Table 3: Multivariate analysis of socio-demographic factors associated with severe malaria in children
under five years
Variable N=380 Severe aOR(95% CI) P-Value
malaria
n(%)
Age of the child
≤2years 161 17(10.6) 1.02(0.51-2.45) 0.002
≥3years 219 14(6.4) Reference
Sex of the child
Male 248 22(8.9) 1.10(0.82-3.37) 0.072
Female 132 09(6.8) Reference
Occupation of caregiver
Farmer 255 24(9.4) 2.20(0.90-5.14) 0.065
Non-farmer 125 07(5.6) Reference
Educational level of the caregiver
None 27 09(33.3) 1.65(0.98-3.73) 0.001
Primary 83 12(14.5) 0.81(0.55-2.01) 0.055
Secondary 178 08(4.5) 0.65(0.32-1.70) 0.482
Tertiary 92 02(2.2) Reference
Marital status of the caregiver
Married 328 18(5.5) Reference
Single 52 13(25.0) 0.78(0.04-1.66) 0.011

Household characteristics as a communication media and 85.8% use pit latrine.

Table 4 below shows the household characteristics Majority (53.9%) had household size ≤5members,
of the study participants. Majority (31.1%) had 83.9% had insecticide treated nets however only
houses with walls made of sand and bricks,97.6% had 62.1% use them. Most (61.3%) were from households
houses roofed with iron sheets,61.6% didn’t have with more than 2 children under five years and
electricity in their houses, majority (37.1%) use radio majority (74.2%) were from monogamous families.

29
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Table 4: Household characteristics
Variable Frequency(N=380) Percentage (%)
What material was used to make the
wall of your house?
Wattle &mud 151 39.7
Wood 99 26.1
Sand and bricks 118 31.1
Plaster and tiles 12 3.2
What material makes up the roof of
your house?
Grass 09 2.4
Wood -
Iron sheets 371 97.6
Do you have electricity in your house?
Yes 146 38.4
No 234 61.6
What communication media do you use
at home?
Television 85 22.4
Radio 141 37.1
Newspapers 120 31.6
Others 34 8.9
What toilet facility do you use at
home?
Flash toilet 43 11.3
Pit latrine 326 85.8
None 11 2.9
Size of the household?
≤5 in number 205 53.9
≥6 in number 175 46.1
Do you have treated mosquito nets at
home?
Yes 319 83.9
No 61 16.1
If yes does the child sleep under a
treated mosquito net?
Yes 198 62.1
No 121 37.9
How many children are under five years
in the household?
1 child 147 38.7
2 and more 233 61.3
What is the type of family?
Polygamous 98 25.8
Monogamous 282 74.2

Bivariate analysis of household factors mosquito nets and using them, number of children
associated with severe malaria among children under five years in the household and type of family
under five years were significant at bivariate analysis and were
Material used to make the wall of the house, material therefore considered for multivariate analysis as
which makes up the roof of the house, toilet facility shown in the table below.
used at home, size of the household, having treated

30
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Table 5: Bivariate analysis of household factors associated with severe malaria among children under five
years
Variable (N=380) Severe malaria in cOR(95% CI) P-value
children under five n(%)
What material was used to
make the wall of your house?
Wattle &mud 151 14(9.3) 2.08(1.07-4.31) 0.193
Wood 99 09(9.1) 1.90(0.56-3.11) 0.024
Sand and bricks 118 07(5.9) 1.00(0.07-2.20) 0.302
Plaster and tiles 12 01(8.3) Reference
What material makes up the
roof of your house?
Grass 09 03(33.3) 1.09(0.78-4.73) 0.051
Wood - - -
Iron sheets 371 28(7.5) Reference
Do you have electricity in
your house?
Yes 146 10(6.8) Reference
No 234 21(4.0) 1.33(0.66-2.94) 0.316
What communication media
do you use at home?
Television 85 03(3.5) Reference
Radio 141 12(8.5) 0.72(0.21-1.67) 0.257
Newspapers 120 11(9.2) 1.27(0.55-2.18) 0.400
Others 34 05(14.7) 2.01(1.03-3.56) 0.328
What toilet facility do you use
at home?
Flash toilet 43 03(7.0) Reference
Pit latrine 326 24(7.4) 1.19(0.88-3.21) 0.045
None 11 04(36.4) 1.50(1.13-4.40) 0.003
Size of the household?
≤5 in number 205 11(5.4) Reference
≥6 in number 175 20(11.4) 1.38(0.91-2.04) 0.120
Do you have treated mosquito
nets?
Yes 319 14(4.4) Reference
No 61 17(27.9) 2.21(1.17-4.15) 0.027
If yes does the child sleep
under a treated mosquito net?
Yes 198 09(4.5) Reference
No 121 22(18.2) 3.69(1.76-5.10) 0.001
How many children are under
five years in the household?
1 child 147 11(7.5) Reference
2 and more 233 20(8.6) 2.08(0.88-4.06) 0.144
What is the type of family?
Polygamous 98 16(16.3) 1.44(0.92-3.49) 0.036
Monogamous 282 15(5.3) Reference

Multivariate analysis of household factors it and number of children below five years in the
associated with severe malaria among children household were significantly associated with severe
under five years malaria among children under five years as shown in
Type of toilet facility used at home, size of the table below.
household, having a treated mosquito net and using

31
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Table 6: Multivariate analysis of household factors associated with severe malaria among children under
five years
Variable (N=380) Severe malaria in aOR(95% CI) P-value
children under five
n(%)
What material was used to
make the wall of your house?
Wattle &mud 151 14(9.3) 1.82(0.70-3.21) 0.054
Wood 99 09(9.1) 1.14(0.29-2.83) 0.070
Sand and bricks 118 07(5.9) 0.76(0.03-1.40) 0.634
Plaster and tiles 12 01(8.3) Reference
What material makes up the
roof of your house?
Grass 09 03(33.3) 0.79(0.38-5.12) 0.082
Wood - - -
Iron sheets 371 28(7.5) Reference
What toilet facility do you use
at home?
Flash toilet 43 03(7.0) Reference
Pit latrine 326 24(7.4) 0.84(0.51-2.20) 0.022
None 11 04(36.4) 1.10(0.93-3.62) 0.016
Size of the household?
≤5 in number 205 11(5.4) Reference
≥6 in number 175 20(11.4) 0.63(0.44-1.54) 0.030
Do you have treated mosquito
nets at home?
Yes 319 14(4.4) Reference
No 61 17(27.9) 1.45(0.76-3.01) 0.006
If yes does the child sleep
under a treated mosquito net?
Yes 198 09(4.5) Reference
No 121 22(18.2) 2.42(1.00-4.04) 0.002
How many children are under
five years in the household?
1 child 147 11(7.5) Reference
2 and more 233 20(8.6) 1.17(0.51-3.47) 0.004
What is the type of family?
Polygamous 98 16(16.3) 0.55(0.45-2.60) 0.089
Monogamous 282 15(5.3) Reference

Health system characteristics reported that they meet the health worker within 2
Most (88.2%) of the participants were from hours of arrival (57.6%) and report to get all their
communities with a health facility, residing a medication when at the health facility (70.8%) as
distance of 2-3km from the health facility (52.9%), shown below.
used boda boda as a means of transport (51.6%),

32
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Table 7: Health system characteristics

Variable Frequency(N) Percentage (%)
Is there any health facility in the
child’s community?
Yes 335 88.2
No 45 11.8
What is the distance of the health
facility from home?
≤1km 88 23.2
2-3km 201 52.9
≥4km 91 23.9
What means of transport do you use to
go to hospital?
Foot 137 36.1
Bicycle 31 8.2
Bodaboda 196 51.6
Motor care 16 4.2
How long does it take you to see the
health worker when you reach the
health facility?

Within 1 hour 79 20.8

Within 2 hours 219 57.6
≥2hours 82 21.6
Do you get all medication when at
health facility?
Yes 269 70.8
No 111 29.2

Bivariate analysis of Health system factors health a health worker while at the health facility
associated with severe malaria in children under and getting all medication when at the health facility
five years were significant and considered for multivariate
Having health facility in the community, distance to analysis as shown in table 5 below.
the health facility, length of time taken to meet

33
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Table 8: Bivariate analysis of Health system factors associated with severe malaria in children under five
years
Variable N Severe Malaria in cOR(95% CI) P-value
children under five
n(%)
Is there any health facility in
the child’s community?
Yes 335 17(5.1) Reference
No 45 14(31.1) 1.15(0.60-3.04) 0.156
What is the distance of the
health facility from home?
≤1km 88 03(3.4) Reference
2-3km 201 16(8.0) 1.02(0.75-4.10) 0.007
≥4km 91 12(13.2) 2.33(1.23-6.41) 0.018
What means of transport do
you use to go to hospital?
Foot 137 18(13.2) 1.58(0.71-3.80) 0.415
Bicycle 31 03(9.7) 0.87(0.22-2.03) 0.528
Bodaboda 196 09(4.6) 0.42(0.03-1.67) 0.311
Motor care 16 01(6.3) Reference
How long does it take you to
see the health worker when you
reach the health facility?

Within 1 hour 79 05(6.3) Reference

Within 2 hours 219 15(6.8) 1.83(0.76-4.99) 0.024
≥2hours 82 11(13.4) 2.00(1.27-5.60) 0.004
Do you get all medication when
at health facility?
Yes 269 19(7.1) Reference
No 111 12(10.8) 2.70(1.19-4.00) 0.169

Multivariate analysis of health system factors According to the study, there was an observed
associated with severe malaria among children association between distance to the health facility,
under five years. waiting hours, getting all medication while at the
health facility and severe malaria among children
under five years as shown in table 9 below.

34
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Table 9: Multivariate analysis of health system factors associated with severe malaria among children
under five years
Variable N Severe Malaria in aOR(95% CI) P-value
children under five
n(%)
Is there any health facility in
the child’s community?
Yes 335 17(5.1) Reference
No 45 14(31.1) 0.75(0.42-2.18) 0.061
What is the distance of the
health facility from home?
≤1km 88 03(3.4) Reference
2-3km 201 16(8.0) 0.83(0.55-3.60) 0.022
≥4km 91 12(13.2) 1.43(0.24-3.94) 0.036
How long does it take you to
see the health worker when you
reach the health facility?

Within 1 hour 79 05(6.3) Reference

Within 2 hours 219 15(6.8) 0.91(0.08-3.00) 0.003
≥2hours 82 11(13.4) 1.70(0.65-3.72) 0.027
Do you get all medication when
at health facility?
Yes 269 19(7.1) Reference
No 111 12(10.8) 1.89(0.57-3.70) 0.042

DISCUSSION
Socio-demographic factors associated with wholesome surroundings. These families have the
severe malaria among children under five years resources to outfit their homes with mosquito-
At multivariate analysis, age of the child, education repelling elements like insecticide-treated mosquito
level of the caregiver and marital status of the nets, screens on windows and doors, and repellents.
caregiver were significantly associated with severe Further, my study found out that children whose
malaria among children under five years. caretakers were single had higher odds of
This study established that children less than 2 developing severe malaria compared to those whose
years were more likely to develop severe malaria caretakers were married. This may be due to less
compared to older ones. Marcelline et al [13] and affordability of malaria preventive measures and
Griffin et al [15] found out that increasing age is prompt malaria treatment among single caregivers.
protective against severe malaria. This may be due Household factors associated with severe malaria
improved immunity with age as result of multiple among children under five years
exposures. Type of toilet facility used at home, size of
The current study found out that prevalence of household, having a treated mosquito net and using
severe malaria was inversely proportional to the it and number of children below five years in the
education level of care takers. This is in agreement household were significantly associated with severe
with a finding of a study in [16–18] which found malaria among children under five years.
that children whose mothers had higher education This study revealed that the prevalence of severe
were less likely to develop severe malaria than those malaria increased with a proportional increase in the
with mothers who had lower education. The level of size of the household. This is supported by the
education of caregivers influences their knowledge, finding of a study in Rwanda [19]. The reason for
attitudes, and practices related to malaria this is that, if there are several people living
prevention. Educated caregivers are better able to together, one of could act as a reservoir for others.
comprehend and put preventative advice into Not owning an insecticide treated net was
practice. Caregivers with education also tend to significantly associated with severe malaria. This
come from affluent families. They reside in study further indicates that use of an insecticide
35
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treated net was a protective factor against severe shown that poor home conditions make it easier for
malaria. This premise is consistent with a study mosquitoes to enter and spread malaria[25].
which revealed that owning an insecticide treated Health care factors associated with severe
net was a protective factor [20, 21]. .In Kenya and malaria among children under five years
Nigeria, widespread ITN use has been shown to According to the study, there was an observed
lower malaria morbidity and mortality [22], using a association between distance to the health facility,
bed net protects from mosquito bites. waiting hours, getting all medication while at the
Children from households with more than two health facility and severe malaria among children
children under five years were more likely to suffer under five years.
from severe malaria. Similar finding was reported by Children travelling a distance of more than 4 km had
Tsegaye and colleagues [23].This implies that higher odds of developing severe malaria. This is
positive family support was hampered by social congruent with the findings of a study which
dynamics related to raising several children. revealed that long distance was significantly
Material used to make the wall of the house, material associated with severe malaria [26-30]. Travel time
used for roofing, having electricity in the house and to a medical institution and related transportation
type of family had no association with severe costs may impact the decision to seek treatment for
malaria. This is inconsistent with the findings of a malaria as soon as possible, which could delay
study in Uganda [24].While a household's access to diagnosis and treatment if caregivers choose to
electricity may be related to that person's begin treatment at home.
socioeconomic standing, it may also influence that Long waiting hours and not getting all the
person's way of life. For example, people who live in medication when in the health facility were
households without electricity may need to go significantly associated with severe malaria [30–34].
outside more frequently, making them more likely to
contract malaria from mosquito bites. Studies have
CONCLUSION
Severe malaria among children under five years is at home, size of household, owning a treated
still a big public health challenge. Factors associated mosquito net, number of children under-five,
with severe malaria among children under five years distance to the health facility, waiting hours and
include age of the child, education level of caregiver, getting all medication while at the health facility.
marital status of caregiver, type of toilet facility used
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CITE AS: Henry Sosolyo (2024). Risk factors associated with severe malaria in children under five years
of age at Jinja Regional Referral Hospital, Uganda. IAA Journal of Biological Sciences 12(2):25-38.
https://doi.org/10.59298/IAAJB/2024/122.253811

38
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provided the original work is properly cited.