Dr. Ibrahim Rasheed Olayinka

Objectives: Cerebral malaria remains poorly understood despite being a common manifestation of severe malaria in children, often associated with poor outcomes. We sought to describe the burden of childhood cerebral malaria and identify factors predictive of poor hospitalization outcomes (death and neurological outcomes) and short-term neurological sequelae. Methods: We conducted a retrospective review of children diagnosed with cerebral malaria at a tertiary hospital in northwestern Nigeria from 1 January 2019 to 31 December 2022. We retrieved relevant information, including hospitalization outcomes (discharge, death, and neurological sequelae) and neurological statusatfollow-up. Results:Of8295pediatricadmissions,948caseswereseveremalaria; from those, 284 cases of cerebral malaria were identified, representing a prevalence of 3.4% and 30.0%, respectively. Clinical and laboratory features were comparable between survivors and non-survivors, except hypoxemia (p = 0.016), duration of loss of consciousness (p < 0.001), acidosis (p = 0.002), white blood cell count (p = 0.006), serum sodium (p = 0.005), and serum creatinine (p < 0.001). Hypoxemia (adjusted odds ratio (AOR) = 6.071; 95% CI: 1.672–22.043), serum creatine > 1.5 mg/dL (AOR = 6.720; 95% CI: 2.160–20.905), and the first 24 hours of hospitalization (AOR = 5.934; 95% CI: 2.423–14.535) were predictors of hospitalization death. Forty-nine (19.6%) of 250 survivors had neurological complications at discharge. Age under five years increased the odds of neurological complications at discharge (OR = 2.059; 95% CI: 1.094–3.876). At follow-up, 24 (49.0%) of the 49 patients with neurological complications recovered fully. Conclusions: This study demonstrates that cerebral malaria is associated with a high mortality rate and significant neurological complications, particularly in children under five years old. Hypoxemia and elevated serum creatinine levels were associated with an increased risk of in-hospital death.

Acute kidney injury (AKI) is a common, life-threatening clinical complication of severe malaria in children associated with increased short- and long-term mortality. Malaria remains a leading cause of child mortality in Africa, where most severe malaria cases and deaths occur, and a few countries account for most of the global disease burden. While some children who develop severe malaria-associated AKI may require dialysis during hospitalization, survi- vors may require long-term care for chronic kidney disease, including maintenance dialysis and kidney transplant. There are variations in the availability and type of dialysis services offered across malaria-endemic African coun- tries with major barriers to accessing kidney transplants. Access remains challenging among countries with dialysis services because these centers are usually located in selected specialized urban hospitals far from most patients. The limited number of available pediatric nephrologists in the region further impacts the delivery of specialized nephrology care. This review provides an overview of the magnitude of malaria-associated AKI in selected malaria- endemic countries, country-specific perspectives on dialysis availability and access, and kidney transplant services availability for children who develop chronic kidney disease.