Severe Malaria in Angola: The Clinical Profile and Disease Outcome Among Adults from a Low-Endemic Area

Severe malaria poses a significant public health concern in Angola, particularly among adults. This study assessed the clinical manifestations and outcomes of severe Plasmodium falciparum malaria in adult patients admitted to Hospital Central Dr. António Agostinho Neto of Lubango (HCL), Angola.

The study retrospectively reviewed medical records of patients over 14 years old admitted with severe malaria during the first quarter of 2021 and 2022, coinciding with the peak transmission season. The World Health Organization (WHO) criteria were used to clarify the disease severity. The cohort included 640 patients-167 in 2021 and 473 in 2022-distributed across the following departments: the Intensive Care Unit (ICU; n = 81), Medicine (MED; n = 458) and Infectiology (INF; n = 101).

The median age was 26 years and 59.4% were males. Renal impairment was the most frequent severe manifestation, affecting 37.4% of cases. The mortality rate across the study period was 7%, showing a notable decrease from 10.2% in 2021 to 5.9% in 2022. The higher mortality rate in 2021 may reflect the impact of the COVID-19 pandemic, which limited hospital access and delayed care, resulting in more critical cases being admitted at a later stage. In 2022, with reduced COVID-19 pressures, earlier access to treatment may have improved outcomes, contributing to the lower mortality rate.

This study emphasizes the need to assess the clinical burden of severe malaria in low-endemic regions, where shifting patterns may signal emerging threats such as antimalarial drug resistance. Further research is essential to optimize control strategies and strengthen surveillance systems, reducing morbidity and mortality.