Blackwater fever in Ugandan children with severe anemia is associated with poor post-discharge outcomes. A prospective cohort study.

12 Jul 2019
Opoka RO, Waiswa A, Harriet N, John CC, Tumwine JK, Karamagi C


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, post-discharge morbidity in children with BWF has hitherto 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 (Hb ≤ 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 with no 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, HR 1.68 (95% CI, 1.1, 2.5), and a greater risk of death, HR 3.37 (95% CI, 1.3 to 8.5), compared to those with no 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 amongst SA children in Jinja hospital. SA children with BWF had increased risk of readmissions and deaths in the post-discharge period. Post-discharge malaria chemoprophylaxis should be considered for SA children living in malaria endemic areas.