Inpatient mortality and predictors among adults hospitalized with severe malaria: a prospective cohort study in Southwest Ethiopia

Abstract

Severe malaria remains a major public health challenge in tropical and subtropical regions, frequently resulting in multi-organ dysfunction and high mortality. Despite intensified control strategies and widespread use of antimalarial therapy, mortality rates remain unacceptably high. Moreover, data regarding inpatient mortality and its predictors at Jimma Medical Center (JMC) in Southwest Ethiopia remains limited. This study aimed to determine the inpatient mortality and predictors among adults hospitalized with severe malaria at JMC from March 1, 2024, to February 28, 2025. A prospective cohort study design was conducted among 250 adult patients hospitalized with severe malaria, using a consecutive sampling technique. Data were collected using Kobo Toolbox and analyzed with IBM SPSS Statistics for Windows, version 27.0. Categorical variables were summarized using frequencies, percentages, and graphs, while continuous variables were summarized using means or medians with standard deviations. Logistic regression analysis was performed to identify factors associated with inpatient mortality among patients with known final outcomes ( n = 225). Statistical significance was set at p < 0.05. Crude and adjusted odds ratios with 95% confidence intervals were used to assess the strength of associations. Of the 250 adult patients hospitalized with severe malaria, 37 died during hospitalization, yielding a crude inpatient mortality rate of 14.8% (95% CI: 10.0–19.0%). In the multivariable logistic regression analysis, presence of comorbidity (AOR = 21.6, 95% CI: 4.646–50.799, P < 0.001), cerebral malaria (AOR = 12.4, 95% CI: 3.069–30.814, P < 0.001), acute kidney injury (AOR = 9.8, 95% CI: 2.828–23.867, P < 0.001), illness duration > 5 days (AOR = 6.1, 95% CI: 1.644–22.489, P = 0.007), and leukocytosis (AOR = 3.9, 95% CI: 1.135–13.866, P = 0.031) were independently associated with increased odds of inpatient mortality. Conversely, female sex (AOR = 0.20, 95% CI: 0.047–0.621; P = 0.007) and formal education (AOR = 0.20, 95% CI: 0.059–0.685; P = 0.010) were independently associated with an 80% lower odds of inpatient mortality. The inpatient mortality rate among adults hospitalized with severe malaria was relatively high. Presence of comorbidity, cerebral malaria, delayed presentation beyond 5 days, acute kidney injury, and leukocytosis were independently associated with increased odds of inpatient mortality. In contrast, female sex and formal education were associated with lower odds of inpatient mortality. These findings underscore the need for timely case detection, improved access to healthcare, and early clinical intervention to reduce mortality from severe malaria. Not applicable.