{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:27:24Z","timestamp":1791390444981,"version":"4.3.3"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Malaria remains a major global health burden, with 264 million cases and 569,000 deaths in 2023. Uganda ranks third globally in malaria cases and tenth in deaths, with 95% of the country endemic and children under five most vulnerable. Despite control efforts, Mbale Regional Referral Hospital (MRRH) in Eastern Uganda reported a pediatric malaria case fatality rate of 2.7% between 2020 and 2024. This study aimed to identify factors associated with malaria-related deaths among children under five admitted to the hospital during this period. We conducted an unmatched 1:2 case\u2013control study using retrospective data from 2020\u20132024. Cases were children \u226459 months with WHO-defined severe\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    malaria who died during hospitalization (n\u2009=\u2009100). Controls were similar children who recovered (n\u2009=\u2009200), systematically sampled from about 32,400 admissions. Data were extracted from patient records, and multivariable logistic regression identified mortality predictors. Among 100 cases, 73% were aged &lt;24 months and 61% were male. Convulsions (adjusted odds ratio [aOR]=17; 95%CI:4.2\u201371), loss of consciousness (aOR=14; 95%CI: 1.4\u2013113), severe anemia (aOR=3.4; 95%CI:1.4\u20138.2), vomiting (aOR=3.1; 95%CI: 1.4\u20136.9), and delays in seeking care\u2009&gt;\u200924 hours after symptom onset (aOR=8.8; 95%CI: 2.3\u201334) were significantly associated with mortality.Malaria deaths among under-five children was significantly associated with severe clinical features,convulsions, loss of consciousness, and severe anemia and delayed care-seeking. Early recognition of danger signs, and prompt care-seeking could reduce paediatric malaria mortality in high-burden settings like Mbale.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0006308","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:43:01Z","timestamp":1776706981000},"page":"e0006308","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Risk factors for malaria-related mortality among children under five at Mbale Regional Referral Hospital, Uganda, 2020\u20132024: A case-control study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8158-9529","authenticated-orcid":true,"given":"Patrick","family":"Kwizera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-9521","authenticated-orcid":true,"given":"Richard","family":"Migisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charity","family":"Mutesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Rukundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Ndugwa","family":"Kabwama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0400-8635","authenticated-orcid":true,"given":"Benon","family":"Kwesiga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Bulage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Riolexus","family":"Ario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"pgph.0006308.ref001","unstructured":"World malaria report 2024: addressing inequity in the global malaria response."},{"key":"pgph.0006308.ref002","year":"2021"},{"issue":"1","key":"pgph.0006308.ref003","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s12936-024-05111-w","article-title":"Risk factors for death among children with severe malaria, Ivukula sub-county, Namutumba district, Eastern Uganda, September 2021\u2013February 2022","volume":"23","author":"MG Zalwango","year":"2024","journal-title":"Malar J"},{"key":"pgph.0006308.ref004","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4269\/ajtmh.21-1305","article-title":"East Africa International Center of Excellence for Malaria Research: Impact on Malaria Policy in Uganda. The","volume":"107","author":"JF Namuganga","year":"2022","journal-title":"American Journal of Tropical Medicine and Hygiene"},{"key":"pgph.0006308.ref005"},{"key":"pgph.0006308.ref006","author":"National Malaria Control Program"},{"key":"pgph.0006308.ref007","author":"Malaria Consortium","year":"2019"},{"issue":"1","key":"pgph.0006308.ref008","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1186\/s12887-025-05768-5","article-title":"Timeliness of malaria treatment in children under five years in Uganda: An analysis of 2016 demographic health survey data","volume":"25","author":"JB Asiimwe","year":"2025","journal-title":"BMC Pediatr"},{"key":"pgph.0006308.ref009","year":"2026"},{"key":"pgph.0006308.ref010","year":"2024"},{"issue":"1","key":"pgph.0006308.ref011","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/s12936-024-05023-9","article-title":"Non-falciparum malaria infections in Uganda, does it matter? A review of the published literature","volume":"23","author":"M Ranjbar","year":"2024","journal-title":"Malar J"},{"key":"pgph.0006308.ref012"},{"key":"pgph.0006308.ref013","first-page":"83","volume-title":"Management of severe malaria: a practical handbook","author":"World Health Organization","year":"2012","edition":"3"},{"issue":"1","key":"pgph.0006308.ref014","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1186\/s12879-020-05215-z","article-title":"The age-specific incidence of hospitalized paediatric malaria in Uganda","volume":"20","author":"A Mpimbaza","year":"2020","journal-title":"BMC Infect Dis"},{"key":"pgph.0006308.ref015"},{"issue":"1","key":"pgph.0006308.ref016","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s12936-024-05159-8","article-title":"Factors associated with severe malaria-related mortality among hospitalized children under five years of age in Eastern Province of Rwanda: A cross-sectional study using hospital records from 2017 to 2021","volume":"23","author":"JP Hategekimana","year":"2024","journal-title":"Malar J"},{"key":"pgph.0006308.ref017"},{"key":"pgph.0006308.ref018","doi-asserted-by":"crossref","first-page":"184","DOI":"10.11604\/pamj.2018.29.184.15235","article-title":"Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo","volume":"29","author":"AM Mutombo","year":"2018","journal-title":"Pan Afr Med J"},{"issue":"8","key":"pgph.0006308.ref019","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1093\/cid\/cis034","article-title":"Predicting the clinical outcome of severe falciparum malaria in African children: Findings from a large randomized trial","volume":"54","author":"L von Seidlein","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pgph.0006308.ref020","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12916-017-0906-5","article-title":"Clinical and laboratory predictors of death in African children with features of severe malaria: A systematic review and meta-analysis","volume":"15","author":"P Sypniewska","year":"2017","journal-title":"BMC Med"},{"key":"pgph.0006308.ref021"},{"issue":"1","key":"pgph.0006308.ref022","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1186\/s12936-018-2509-9","article-title":"Anaemia and malaria","volume":"17","author":"NJ White","year":"2018","journal-title":"Malar J"},{"key":"pgph.0006308.ref023","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4274\/cayd.86570","article-title":"Sudden unexpected death in a child with vomiting and diarrhea due to intracranial mass lesion","author":"EB Akkoyun","year":"2017","journal-title":"cayd"},{"key":"pgph.0006308.ref024","article-title":"Hypovolemia and hypovolemic shock","volume-title":"StatPearls","author":"S Taghavi","year":"2025"},{"issue":"1","key":"pgph.0006308.ref025","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s12936-024-05038-2","article-title":"Patient socio-demographics and clinical factors associated with malaria mortality: A case control study in the northern region of Ghana","volume":"23","author":"NY Peprah","year":"2024","journal-title":"Malar J"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006308","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:43:06Z","timestamp":1776706986000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006308"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006308","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}