Prognostic factors for death in patients hospitalised with malaria in pediatric units at the regional hospital centre in Dori, Burkina Faso

Abstract

BACKGROUND: Africa bears a disproportionate share of the global burden of malaria. However, few studies have dealt with the prognostic factors of malaria deaths in hospitals. This study followed a cohort of children aged 1-59 months hospitalized for malaria to identify factors associated with mortality. The findings aim to assess the prognostic factors for death in patients hospitalized with pediatric malaria at the Regional Hospital Centre (RHC) in Dori. METHODS: Children aged 1-59 months hospitalized in the pediatric ward of the RHC in Dori, diagnosed with malaria based on fever or a history of fever with a positive thick blood smears or rapid diagnostic test, were systemically included from August 1 to September 30, 2022. Cases with mixed infections or false positives were excluded through rigorous diagnostic criteria, including clinical evaluation and laboratory confirmation. Cox regression analysis was chosen for its ability to handle time-to-event data and assess the impact of multiple covariates on survival. Variables were first analyzed univariably, followed by stepwise elimination to construct a multivariable model. RESULTS: Among 444 patients observed, the case fatality rate for malaria was 14.4% (n = 64), with a median time to death of 5 days. Significant prognostic factors included respiratory distress (HR = 3.8; 95% CI = 2.2-6.6), hypoglycemia (HR = 3.1; 95% CI = 1.8-5.3), shock (HR = 4.1; 95% CI = 1.9-8.7), altered consciousness (HR = 2.1; 95% CI = 1.2-3.5), acute gastroenteritis (HR = 2.3; 95% CI = 1.3-4.2), and hyperparasitemia (HR = 3.8; 95% CI = 1.1-12.9). The hazard ratio (HR) represents the likelihood of death at any given time for patients with a specific risk factor compared to those without it. CONCLUSIONS: The study highlights modifiable risk factors for death among hospitalized pediatric malaria patients, underscoring the need for targeted interventions, such as improved access to oxygen therapy and transfusions. The findings are relevant for health policy planning in resource-limited settings.