Burden, Clinical Spectrum, Predictors of Severe Anaemia, and Inhospital Outcomes of Pediatric Severe Malaria: A Retrospective study from a Tertiary Hospital Cohort

Abstract

Severe malaria (SM) remains a leading cause of childhood morbidity and mortality in Nigeria, with severe malarial anaemia (SMA) driving transfusion demand and poor outcomes. Recent contemporary hospital-based data from Southwestern Nigeria are limited. This study described the burden, clinical spectrum, predictors of severe anaemia, and in-hospital outcomes of paediatric SM at a tertiary hospital in Southwest Nigeria. We retrospectively reviewed case records of children aged 1 month–14 years admitted with SM to Olabisi Onabanjo University Teaching Hospital, between January–December 2023. Demographic, clinical, laboratory, treatment, and outcome data were extracted while predictors of SMAwere assessed using logistic regression. Of 699 paediatric admissions, 65 (9.3%) were confirmed SM cases; 55.4% were <5 years, and 72.3% males. Nearly two-thirds were underweight, and 89% belonged to low-middle socioeconomic classes. The most frequent WHO severity criteria were multiple convulsions (35.4%), prostration (33.8%), cerebral malaria (16.9%), and SMA (16.9%). Eleven children developed SMA; with pallor as a presenting complaint being the strongest independent predictor (adjusted OR 8.94, 95% CI 1.60–49.8, p=0.012). All patients received intravenous artesunate, and 87.5% received empiric antibiotics. Median hospital stay was 6 days (IQR 3.5–9.5). Overall survival was 96.9%, with 2 deaths (3.1%). However, 18.5% were discharged against medical advice. Conclusively, severe malaria accounted for nearly one-tenth of paediatric admissions, predominantly affecting under fives and socioeconomically disadvantaged children. Pallor strongly predicted SMA, underscoring its bedside triage value. High survival with artesunate contrasts with high discharged-against-medical-advice rates, highlighting the need for caregiver support and financial protection.