Risk Factors of Mortality Related to Severe Malaria among Children in Referral Hospitals of Kisangani

Abstract

Aims: This study aimed at determining the factors associated with mortality in childhood severe malaria in Kisangani. For Democratic Republic of Congo is one of African countries with highest mortality rate of under-five children. Study Design:  cross-sectional study. Place and Duration of Study: Data were collected from medical folders of all children of 6 months to 16 years-old, hospitalized in 4 general reference hospitals (GRH) of Kisangani town, from January to December, 2015.  We selected only children with severe malaria confirmed by a positive thick blood smear and/or positive rapid diagnostic test.  Methodology: Sociodemographic and clinical data of deceased children were compared to those of alive or controls. Association of severity criteria and other factors to fatal prognosis was assessed by chi-square or Yate’s adjustment. Bivariate analysis used odds ratio to evaluate the risk of dying. Means were compared by test t of student. Results: Among 3410 children hospitalized for miscellaneous causes, 1194 had clinical and 845 confirmed severe malaria. The sex ratio M/F was 1.34. Most of children were under 5 years old (73.1%) and the most frequent severity criterion of malaria was pallor, followed by respiratory distress, icterus and coma. Quinine was used in 84.3%. Twenty-nine out of 845 children died (3.43%) and factors associated to this fatality were male sex (P= .04), age under 5 years-old (P =.002). The risk of dying was high when children had circulatory collapse or shock (P < .001), coma (P = .0008), icterus (P = .003), and ≥ 2 severity criteria (P = .005). Sixty-six percent received antibiotics without any microbiological exam.   Conclusion: The malaria-related mortality is still high and associated with avoidable factors. Supervising health workers in GRH and providing them with more technical assistance to address complications in severe malaria can help to save more children.