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In the current study, the clinical epidemiology of severe malaria in Mbale, Eastern Uganda, is described, where the entomological inoculation rate exceeds 100 infective bites per year.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A prospective descriptive study was conducted to determine the prevalence, clinical spectrum and outcome of severe <jats:italic>Plasmodium falciparum<\/jats:italic> malaria at Mbale Regional Referral Hospital in Eastern Uganda. All children aged 2\u00a0months\u201312\u00a0years who presented on Mondays to Fridays between 8.00 am and 5.00\u00a0pm from 5th May 2011 until 30th April 2012 were screened for parasitaemia. Clinical and laboratory data were then collected from all <jats:italic>P. falciparum<\/jats:italic> positive children with features of WHO-defined severe malaria by use of a standardized proforma.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 10\u00a0208 children were screened of which 6582 (64%) had a positive blood film. Of these children, 662 (10%) had clinical features of severe malaria and were consented for the current study. Respiratory distress was the most common severity feature (554; 83.7%), while 365\/585 (62.4%) had hyperparasitaemia, 177\/662 (26.7%) had clinical jaundice, 169 (25.5%) had severe anaemia, 134\/660 (20.2%) had hyperlactataemia (lactate\u2009\u2265\u20095\u00a0mmol\/L), 93 (14.0%) had passed dark red or black urine, 52 (7.9%) had impaired consciousness and 49\/662 (7.4%) had hypoxaemia (oxygen saturations\u2009&lt;\u200990%). In-hospital mortality was 63\/662 (9.5%) overall but was higher in children with either cerebral malaria (33.3%) or severe anaemia (19.5%). Factors that were independently associated with mortality on multivariate analysis included severe anaemia [odds ratio (OR) 5.36; 2.16\u20131.32; <jats:italic>P\u2009<\/jats:italic>=\u20090.0002], hyperlactataemia (OR 3.66; 1.72\u20137.80; <jats:italic>P\u2009<\/jats:italic>=\u20090.001), hypoxaemia (OR) 3.64 (95% CI 1.39\u20139.52; <jats:italic>P\u2009<\/jats:italic>=\u20090.008), and hepatomegaly (OR 2.29; 1.29\u20134.06; <jats:italic>P\u2009<\/jats:italic>=\u20090.004). No independent association was found between mortality and either coma or hyperparasitaemia.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Severe childhood malaria remains common in Eastern Uganda where it continues to be associated with high mortality. An unusually high proportion of children with severe malaria had jaundice or gave a history of having recently passed dark red or black urine, an issue worthy of further investigation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12936-020-03390-7","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T11:03:42Z","timestamp":1599131022000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["The clinical spectrum of severe childhood malaria in Eastern Uganda"],"prefix":"10.1186","volume":"19","author":[{"given":"Peter","family":"Olupot-Olupot","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Engoru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Nteziyaremye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Chebet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonny","family":"Ssenyondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Muhindo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Nyutu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander W.","family":"Macharia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Uyoga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyne M.","family":"Ndila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Karamagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Maitland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4456-2382","authenticated-orcid":false,"given":"Thomas N.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,3]]},"reference":[{"key":"3390_CR1","unstructured":"World Health Organization, World Malaria Report 2019 [https:\/\/www.who.int\/publications\/i\/item\/world-malaria-report-2019]."},{"key":"3390_CR2","first-page":"50","volume":"4","author":"R Idro","year":"2004","unstructured":"Idro R, Aloyo J. 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The study conformed to the provisions of ethical standards in Uganda.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The Mbale Clinical Research Institute (MCRI, ), a research entity affiliated to the Uganda National Health Research Organization, approved the publication of this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"322"}}