Trends of incidence and outcomes of childhood severe malaria in Nigeria: A four-year study from 2019 to 2022.

Abstract Background 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 study of children with severe malaria between January 1st, 2019 and December 31st, 2022.We extracted relevant data, including socio-demographics, 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 57.4% observed in 2019 to 54.8% in 2022, p = 0.019). The crude mortality rate was 7.2% (68/948) and 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 deaths (from pediatric deaths) 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 mortality rate [from 3.2% in 2019 to 10.2% in 2020, 6.4% (2021) and 10.3% in 2022, p = 0.104] and the proportion of 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%). Conclusions Despite the initial surge in severe malaria cases during the COVID-19 era, there has been an overall progressive decline in childhood severe malaria. However, among those under-fives, the trends in malaria deaths remained unchanged.