Outcomes of childhood severe malaria: a comparative of study pre-COVID-19 and COVID-19 periods

Olayinka Rasheed Ibrahim; Michael Abel Alao; Bello Mohammed Suleiman; Olugbenga Ayodeji Mokuolu

doi:10.1186/s12887-023-03985-4

Outcomes of childhood severe malaria: a comparative of study pre-COVID-19 and COVID-19 periods

BMC Pediatr. 2023 Apr 15;23(1):177. doi: 10.1186/s12887-023-03985-4.

Authors

Olayinka Rasheed Ibrahim^{1

2}, Michael Abel Alao³, Bello Mohammed Suleiman¹, Olugbenga Ayodeji Mokuolu^{4

5}

Affiliations

¹ Department of Pediatrics, Federal Teaching Hospital, Katsina, Katsina State, Nigeria.
² Department of Pediatrics, University of Ilorin Teaching Hospital, & University of Ilorin, Ilorin, Kwara State, Nigeria.
³ Department of Pediatrics, University College Hospital, & University of Ibadan, Ibadan, Oyo state, Nigeria.
⁴ Department of Pediatrics, University of Ilorin Teaching Hospital, & University of Ilorin, Ilorin, Kwara State, Nigeria. mokuolu@unilorin.edu.ng.
⁵ Department of Pediatrics and Child Health, University of Ilorin, Ilorin, Kwara State, Nigeria. mokuolu@unilorin.edu.ng.

Abstract

Background: The collateral damages from measures adopted to mitigate the coronavirus disease 2019 (COVID-19) pandemic have been projected to negatively impact malaria in sub-Saharan Africa. Herein, we compare the prevalence and outcomes of childhood severe malaria during the pre-COVID-19 and COVID-19 periods at a tertiary health facility in Nigeria.

Methods: This was a retrospective review of cases of severe malaria admitted from 1st January to 31st December 2019 (pre-COVID-19 period) and 1st January to 31st December 2020 (COVID-19 period). We extracted relevant information, including demographics, the duration of symptoms before presentation, forms of severe malaria, and outcomes of hospitalization (discharged or death).

Results: In the pre-COVID-19 period, there were a total of 2312 admissions to the EPU and 1685 in the COVID-19 period, representing a decline of 27%. In contrast, there were 263 and 292 severe malaria admissions in the pre-COVID-19 and COVID-19 periods, respectively, representing an 11% increase in the absolute number of cases. The prevalence rates were 11.4% in the pre-COVID-19 period and 17.3% in the COVID-19 period, representing an increase of 52% in the percentage differences. The mortality rate in the COVID-19 period was higher than the pre-COVID-19 period ([10.3%; 30/292 vs. 2.3%; 6/263], p 0.001). The death rate increased by 350% during the COVID-19 period. The odds ratio (OR) of a child dying from severe malaria in the COVID-19 era was 4.9 [95% confidence interval (CI): 2.008 to 11.982]. In the COVID-19 era, presentation at a health facility was also delayed (p = 0.029), as were the odds of multiple features of severe malaria manifestations (OR-1.9, 95% CI, 1.107 to 3.269; p = 0.020).

Conclusion: This study shows that the prevalence of severe childhood malaria increased by as much as 11.0%, with a disproportionate increase in mortality compared to the pre-pandemic level. Most children with severe malaria presented late with multiple features of severe malaria, probably contributing to the poor hospitalization outcomes (death) observed in this study.

Keywords: COVID-19; Children; Nigeria; Outcomes; Prevalence; Severe malaria.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Child
Hospitalization
Humans
Malaria* / epidemiology
Patient Discharge
Retrospective Studies