Outcomes and factors associated with severe malaria-related anaemia in paediatric patients in northern Nigeria

Objective: To determine the prevalence of anaemia, clinical features, hospitalisation outcomes, and associated factors among paediatric patients with severe malaria-related anaemia admitted to a tertiary hospital in northwestern Nigeria.Design: This was a retrospective study of children with confirmed severe malaria-related anaemia admitted between 2019 and 2022.Participants: Paediatric patients aged three months to 14 years with confirmed severe malaria-related anaemiaMain outcomes measures: Hospitalization outcomes and associated factors among paediatric study patients.Results: There were 278 malaria-related anaemia cases with a prevalence of 29.3% (278/948) among malaria cases and 3.4% (278/8,295) among all paediatric admissions. Of 278 patients with malaria-related anaemia, 110 (39.6%) had severe anaemia. The prevalence of severe anaemia was 11.6% (110/948) and 1.3% (110/8,295) from malaria cases and paediatric admissions, respectively. Clinical features were comparable across the levels of anaemia except for the loss of consciousness (p = 0.038). Severe anaemia was more common among under-fives (76/159, 47.8%), p=003, and males (p = 0.013). The crude mortality rate was 6.5% (18/278) and comparable [6.4%, (7/110)] with severe anaemia (p = 0.924). Factors that were associated with hospitalisation deaths included unconsciousness [adjusted odds ratio (AOR) 5.8, 95% confidence interval (CI) 1.800-18.441], hypoxemia AOR [7.3, 95% CI, 1.749- 30.473] and first 24 hours of admission, AOR [18.4, 95% CI 3.430-98.705].Conclusion: In childhood, severe malaria anaemia remains a greater burden among under five and is associated with high mortality. Unconsciousness and hypoxemia at presentation and the first 24 hours of admission were associated with increased odds of death.