Impact of COVID-19 on outcomes of childhood severe malaria: A comparative of study pre-COVID-19 and COVID-19 periods

Background: The collateral damages from measures adopted to mitigate the COVID-19 pandemic have been projected to impact negatively on malaria in sub-Saharan Africa. Herein, we compared the prevalence and outcomes of childhood severe malaria during pre-COVID-19 and COVID-19 periods at a tertiary health facility in Nigeria. Methods This was a retrospective review of cases of severe malaria admitted from 1st January to 31st December 2019 (pre-COVID-19 period) and 1st January to 31st December 2020 (COVID-19 period). We extracted relevant information including demographics, duration of symptoms before presentation, forms of severe malaria, and outcomes of hospitalization (discharged or death). Results In the pre-Covid period, there were a total of 2312 admissions to the EPU and 1685 in the covid period representing a decline of 27%. In contrast, there were 263 and 292 severe malaria admissions in the pre-COVID-19 and COVID-19 periods, respectively, representing an 11% increase in the absolute number of cases. The prevalence rates were 11.4% in the pre-COVID-19 period and 17.3% in the COVID-19 period representing an increase of 52% in the percentage differences. The mortality rate in COVID-19 period was higher than the pre-COVID-19 period ([10.3%;30/292 vs 2.3% 6/263], p < 0.001). The death rate increased by 350.0% during the COVID-19 period. A child is five times more likely to die from severe malaria in the COVID-19 era than in pre-COVID time (4.9, 95% CI 2.008, 11.982). In the COVID-19 era, presentation at a health facility was also delayed (p = 0.029), as were the odds of multiple features of severe malaria manifestations (p = 0.020). Conclusion. This study shows that the prevalence of severe childhood malaria increased by as high as11.0%, with a disproportionate increase in mortality compared to the pre-pandemic level. Most children with severe malaria presented late with multiple features of severe malaria probably contributing to the poor hospitalization outcomes (death) observed in this study.