Long Term Haematological Recovery of Children with Severe Malaria Anaemia in Uganda

Long Term Haematological Recovery of Children with Severe Malaria Anaemia in Uganda

Ruth Namazzi, Andrea Conroy, Dibyadyuti Datta, Gloria Kyarisiima Chandy John, Robert Opoka

Background Children with severe malaria anaemia are at an increased risk of poor post discharge outcomes including frequent readmissions and clinic visits for malaria. How the post-discharge outcomes affect haematological recovery of children after severe malaria anaemia has not been evaluated.

Methods We enrolled and followed up for 12 months 248 children with severe malaria anaemia (SMA) and 120 age matched asymptomatic community controls (CC). Complete blood counts, reticulocyte percentages and erythropoietin levels were done at baseline, 1 month and 12 months after the malaria episode. Children were treated according to national guidelines, which included blood transfusion and anti malarial therapy. We evaluated the relationship between recovery of haematological indices and multiple readmissions in the post-discharge period in SMA children.

Results The mean age was 2.12 ± 0.9 and 2.2 ± 1.0 years (p=0.266) for SMA and CC respectively. The mean baseline haemoglobin (Hb), reticulocyte percentage and erythropoietin levels were 3.5 ± 0.9g/dL, 2.6±4.7% and 6843±5891 for SMA, compared to 10.8±1.5g/dL, 1.8±2.6% and 58.5 for CC, respectively. By 1-month, SMA children had made complete haematological recovery with mean Hb, reticulocyte percentage and erythropoietin levels of 11.2 ± 2.2g/dL, 1.8± 2.7% and 20.2 ± 58.3. The hematological recovery was sustained even by month12 follow up; mean Hb level was 10.7±2.1 and 11.6±2.1g/dL for SMA and CC, p =0.07. Reticulocyte percentages were comparable between SMA and CC, 2.5 ± 4.1vs 1.2±1.7,p=0.41. Amongst SMA group, more children who had multiple readmissions during the follow up period were still anemic at 12 months compared to those who did not have multiple readmissions, 7/64(10.9%) vs. 13/168(7.8%). The difference however was not statistically significant (p=0.438).

Conclusion Children with SMA achieve hematological recovery by 1 month post-discharge. The hematological recovery was maintained until 12 months post-discharge. Amongst SMA children, multiple readmissions in the post-discharge period did not appear to adversely affect hematological recovery by 12 months. The effect of repeated malaria episodes on long term haematological recovery needs further study.