Factors associated with malaria parasitemia in hospitalized children under five years of age with severe acute malnutrition in Burundi: a retrospective cross-sectional study

Malaria and severe acute malnutrition (SAM) are among the leading causes of morbidity and mortality in children under 5 years of age in sub-Saharan Africa. When these conditions occur, they interact synergistically, exacerbating disease severity and compromising child survival. This study aimed to determine the prevalence of malaria parasitemia and identify factors associated with malaria parasitemia among children under five years of age with severe acute malnutrition admitted to Butezi District Hospital, Burundi, between 2023 and 2024. A retrospective cross-sectional study was conducted using the medical records of children under 5 years of age diagnosed with SAM at Butezi District Hospital, Burundi. Malaria parasitemia was diagnosed using either microscopy or rapid diagnostic tests (RDTs), according to routine hospital practice. Descriptive statistics were used to characterize the study population. Associations between SAM and malaria parasitemia were examined via chi-square tests and logistic regression models. Statistical significance was established at p < 0.05. A total of 481 children under five years of age with SAM were included in the study. Malaria parasitemia was detected in 150 (31.2%) children. Among all participants, 275 (57.2%) were diagnosed using microscopy and 206 (42.8%) using RDTs. Girls had higher odds of malaria parasitemia than boys (OR = 1.52, p = 0.042), while children who did not use mosquito nets had nearly twice the odds of malaria parasitemia (OR = 1.97, p = 0.002). Compared with children whose fathers were farmers, those whose fathers were civil servants (OR = 0.18, p < 0.001) or merchants (OR = 0.21, p < 0.001) had significantly lower odds of malaria parasitemia. In sex-stratified analyses, edema (aOR = 2.00, p = 0.037) and lack of mosquito net use were significantly associated with malaria parasitemia among boys, whereas age younger than 6 months (aOR = 3.21, p = 0.034) was significantly associated with malaria parasitemia among girls. Integrated interventions addressing both malnutrition and malaria, alongside targeted prevention strategies, are essential to reduce child morbidity and mortality in resource-limited settings.