Trends of Incidence and Outcomes of Childhood Severe Malaria in a Tertiary Health Facility in Nigeria: A 4-Year Cross-Sectional Study from 2019 to 2022

Abstract Objective Nigeria ranks highest globally in malaria burden, disproportionately affecting children. This study investigated trends in the incidence and outcomes of 948 children with cases of severe malaria in a tertiary hospital in northwestern Nigeria. Methods We conducted a retrospective cross-sectional study of children with severe malaria between January 1, 2019, and December 31, 2022. We extracted relevant data, including sociodemographics, clinical features, as well as hospitalization outcomes (death or discharge), and the trends analyzed over the period. Results Of the 8,295 pediatric admissions during the study period, 948 (11.4%) were cases of severe malaria. The trends of severe malaria (incidence) showed a surge of 17.3% in 2020 from 11.4% in 2019 and subsequently declined to 9.9% in 2022 (p < 0.001). There was a decline in the proportion of under-fives with severe malaria from 47.5% observed in 2019 to 43.7% in 2022 (p = 0.019). The overall mortality rate (malaria specific) was 7.2% (68/948) which rose from 2.3% in 2019 to 10.3% in 2020 and declined to 8.5% in 2022, p = 0.003. The proportion of malaria-specific deaths (from all-cause mortality) increased from 4.6% in 2019 to 17.3% in 2020 and declined to 9.3% in 2022 (p = 0.004). Among under-fives, there was no significant change in the malaria-specific mortality rate (from 3.2% in 2019 to 10.2% in 2020, 6.4% in 2021 and 10.3% in 2022, p = 0.104) and the proportion of malaria-specific deaths in under-fives among malaria deaths (from 66.7% in 2019 to 52.9% in 2022, p = 0.653). Among the clinical features, the presence of cerebral malaria and acute kidney injury had the highest case fatality rate (57.1%). Conclusion Despite the initial surge in severe malaria cases during the coronavirus disease 2019 era, there has been an overall progressive decline in childhood severe malaria. However, among those under-fives, the trends in malaria deaths remained unchanged.