Assessment of infection

On admission, all children were assessed for signs of infection. Acute infection was defined as the presence of sepsis, malaria, or urinary tract infection. Sepsis was defined using the Systemic Inflammatory Response Syndrome (SIRS)/sepsis in international pediatric sepsis consensus guidelines, as previously described.³⁶ The diagnosis of a urinary tract infection was based on a positive nitrite or leukocyte test result by urinalysis in children who presented with fever. Malaria was diagnosed by Giemsa-stained thick and thin blood smears, according to standard protocols. Blood and urine cultures were not available.