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Determinants of outcomes of childhood severe Malaria: A multi-centric study
Mahfuz Babatunde Adigun1, Michael Abel Alao2, Abimbola Ellen Akindolire2
1Department of Pediatrics, University College Hospital, Ibadan, Oyo State, Nigeria.
Insights
Severe malaria in children poses a significant mortality risk. Key factors increasing mortality include shock and the critical first 24 hours post-admission, highlighting the need for prompt intervention.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Severe malaria (SM) remains a critical global health issue, particularly impacting children in endemic regions.
- Understanding factors influencing childhood SM outcomes is vital for developing effective prevention and treatment strategies.
Purpose of the Study:
- To identify determinants of in-hospital mortality in children with severe malaria.
- To inform the development of early warning scores and targeted interventions.
Main Methods:
- Retrospective, multicenter study (2019-2022) of children diagnosed with SM per WHO criteria.
- Multivariate logistic regression analysis to determine mortality predictors.
- Bivariate analysis to identify significantly associated factors.
Main Results:
- Out of 7765 admitted children, 997 (12.8%) had SM. Common manifestations included anemia, hemoglobinuria, cerebral malaria, and prostration.
- In-hospital mortality determinants were identified as the first day of admission (OR: 24.44) and shock (OR: 17.68).
- Severe acute kidney injury and respiratory distress syndrome required dialysis and mechanical ventilation, respectively.
Conclusions:
- Severe malaria continues to present a substantial risk of mortality.
- The initial 24 hours post-admission and the presence of shock are critical determinants of increased mortality.
- These findings underscore the urgency of timely medical intervention for severe malaria cases.
Backgrounds:
Severe malaria (SM) has remained a major global health challenge, disproportionately affecting children in endemic areas. Understanding the factors that influence childhood SM outcomes is critical for developing contextualized early warning scores, effective prevention, and treatment strategies.
Methods:
This is a retrospective, multicenter study conducted between year 2019 and 2022 involving children diagnosed with SM based on World Health Organization (WHO) diagnostic criteria. Multivariate logistic regression was used to identify the determinants of in-hospital mortality from significantly associated factors on bivariate analysis.
Results:
Of the 7765 children admitted to emergency rooms, 997 (12.8%) had SM, with a median age of 4 (IQR: 2.7). M: F ratio of 1.2:1. Anemia (353: 35.4%), hemoglobinuria (348: 34.9%), cerebral malaria (331: 33.1%), and prostration (325: 32.6%) were the most common manifestations of SM. Half (494, 49.5%) of the children had only one form of SM, followed by a combination of three forms (270: 27.1%) of SM. Nine of 43 children with severe acute kidney injury received peritoneal dialysis, while 19 received haemodialysis. Severe shock (75.0%) and a patient with respiratory distress syndrome received mechanical ventilation support. The determinants of increased mortality included the first day of admission [OR (95% CI):24.44 (9.792, 61.007)], and manifestations of shock with a 17-fold [OR (95% CI): 17.682 (4.159, 75.196)] increased mortality.
Conclusion:
SM still carries a significant risk of increased mortality, the need for dialysis, and mechanical ventilation support. The first 24 h after admission, as well as the shock, are determinants of increased mortality.
