Determinants of outcomes of childhood severe Malaria: A multi-centric study

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. 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. 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. 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.