# Estimating Survival Functions in Children With Malaria in South Sudan: A Comparative Analysis of Associated Factors

## TL;DR

This study estimates survival times for children with malaria in South Sudan and finds that treatment with quinine and lack of comorbidities improve survival.

## Contribution

The study provides new insights into survival differences based on treatment and comorbidity in children with malaria in South Sudan.

## Key findings

- The median survival time for children with malaria was three days.
- Children treated with quinine and those without comorbidities had better survival rates.
- Comorbidity and treatment type significantly impacted survival (p < 0.05).

## Abstract

Introduction: Malaria remains one of the major health problems worldwide. It is a leading cause of morbidity and mortality in South Sudan, especially in children. The aim of this study was to estimate the survival functions of children with malaria and to compare these functions with respect to the associated factors.

Methods: This was a retrospective cohort study that utilized data extracted from records of children aged 1 month to 15 years who were diagnosed with malaria and admitted to Al Sabah Children's Hospital, Juba, South Sudan from 1 January to 31 December 2021. Kaplan-Meier was employed to estimate the survival functions, and the log-rank test statistic was used to compare survival curves with respect to categories of specific covariates.

Results: Out of 6,410 children diagnosed with malaria who were included in this study, 3,595 (56.08%) were males and 2815 (43.92%) were females. A total of 303 (4.73%) died and 6,107 (95.27%) were censored. The median survival time was three days (IQR 2-4), and the mean age of the study cohort was 23.66 months (95% CI: 23.01 to 24.32). Comorbidity status among children indicated that 1,552 (24.01%) had comorbidities during admission. With respect to the treatment covariate, 3,920 (61.15%) were treated with artesunate. Kaplan-Meier survival curves showed increased survival for children treated with quinine and those without comorbidity. The log-rank test revealed that the covariates treatment and comorbidity were significant (p < 0.05), both having an impact on survival among children.

Conclusion: This study found that the median survival time for children with malaria was three days. Additionally, comorbidity decreased survival among children. Treatment with quinine showed better survival rates compared to artesunate, despite studies suggesting artesunate as a replacement for quinine. Strengthening the healthcare system, provision of good-quality drugs, and implementing control intervention measures to reduce the transmission of malaria are essential for improving child survival in the country. Furthermore, it is essential to carry out a comparative study of quinine and artesunate for the treatment of malaria. Future studies on malaria in South Sudan have to be conducted by using a prospective study design to address the challenges of incomplete data and potential biases.