Ashley Wade is a medical student at Icahn School of Medicine at Mount Sinai and is mentored by Ross Boyce, MD, MSc. In many parts of Sub‑Saharan Africa, malaria is still one of the main reasons children are hospitalized. In a recent study, Wade and Annika Gunderson, a UNC Epidemiology PhD student, examined how flooding and its disruptions to daily life drive pediatric malaria hospitalizations in rural, flood‑prone communities in western Uganda.
Drawing on baseline data from an ongoing clinical trial, the Uganda-based team collected information from over 9,000 children in 79 villages across three river catchment areas. They asked whether each child had been hospitalized for malaria in the past year and linked that to household flooding, socioeconomic status, bed net use and condition, and malaria rapid test results. About 16% of children had been hospitalized, and those from flooded homes were disproportionately represented. Flood‑affected children missed nearly twice as many days of school, and their caregivers lost more than double the days of work compared with families whose children were not hospitalized.
When the team ran multivariable models, they found that children with indirect flooding exposure, defined as household disruptions to work, healthcare, market, or school access, had a 49% higher risk of hospitalization, while those whose homes were directly flooded had a 77% higher risk. Among all factors, caregiver work disruption showed the strongest link to hospitalization, suggesting that when floods undermine livelihoods, families may delay or struggle to access timely care, allowing malaria to become severe. Bed nets were common in both groups, but hospitalized children were far more likely to sleep under damaged nets, pointing to net quality as a possible mediator of infection in addition to net usage.
The team’s findings acknowledge that malaria hospitalization isn’t just about exposure to mosquitoes; it’s about where families live, how floods reshape their lives, and whether they can access care quickly. This study points toward geographically targeted interventions in flood‑prone communities—protecting caregiver livelihoods, improving bed net quality, and planning for access to care during and after floods—as key drivers for reducing severe malaria in children.