Abstract:
Background: Malaria is a disease caused by a parasite “plasmodium”. This disease is a leading cause of death worldwide, and remains one of the most important global public health problems, with an estimated 2 billion malaria cases and 11.7 million malaria deaths from 2000 to 2021. Most cases (82%) and deaths (95%) occurred in the African region. In Rwanda, the incidence of malaria decreased from 198 cases per 1000 person-years in 2019-2020 to 114 cases per 1000 person-years in the 2020-2021 fiscal year. Delayed treatment of uncomplicated malaria progresses to severe malaria, which is multi-syndromic, often characterized by cerebral malaria (coma caused by P. falciparum infection), severe malaria anemia, and/or respiratory distress. In the current study, we are investigating factors associated with severe malaria in the Kigeme District Hospital catchment area from July 2021 to June 2022.
Methods: An unmatched case-control study was conducted involving secondary and primary data in the catchment area of Kigeme District Hospital from July 2021 to June 2022. In this study, we included people diagnosed with malaria and treated for malaria. A total of 109 severe malaria (cases) were selected from the hospital register using a simple random sampling method and 218 uncomplicated malaria cases (controls) were selected from the health center registers using a systematic random sampling method at a ratio of 1 to 2. Sociodemographic, household, environmental, and clinical data were also collected. Data were analyzed using Stata version 14. Bivariate and multivariate logistic regression models were used to determine the factors associated with severe malaria at 95% significance level.
Results: In total, 327 participants were considered, including 109 cases and 218 controls. The mean age of the study participants was 24 years. Having comorbidities (AOR:2.46; 95% CI:1.13- 5.37), having a history of malaria (AOR:3.70; 95% CI:2.00-6.86), administration of medication at home before seeking medical care (AOR:4.04; 95% CI:1.1-14.81), and delay in seeking healthcare (AOR:14.74; 95% CI:7.96-27.32) were statistically significant independent factors associated with severe malaria among people diagnosed and treated for malaria
Conclusion: Having comorbidities, a history of malaria, and administration of medication at home before seeking medical care and delay in seeking health care were the major factors associated with severe malaria in the Kigeme District Hospital catchment area. These findings highlight the xii need to reinforce interventions aimed to prevent, control and monitoring of malaria in the population
