Outcome determinants in pediatric severe malaria: evidence from a tertiary care hospital in Odisha

Abstract

Background: The objectives of the study were to assess socio-demographic, clinical, and laboratory predictors of outcomes in pediatric patients with severe malaria, focusing on sex-based differences and complication profiles.

Methods: A cross-sectional study was conducted among 102 children aged 0–14 years with confirmed severe malaria admitted to a tertiary care hospital. Data on socio-demographic characteristics, clinical features, and laboratory abnormalities were collected. Outcomes were categorized as treated, referred, or deceased. Associations between variables and outcomes were analyzed using the Chi-square test, with Cramer’s V for effect size. A p value <0.05 was considered statistically significant.

Results: Most participants were aged 5–10 years (47.1%), female (58.8%), from rural areas (76.5%), and of upper-lower socio-economic class (86.3%). The most frequent complications were severe anemia with prostration (29.4%), prostration alone (25.5%), and renal failure with prostration (15.7%). Overall, 80.4% were successfully treated, 11.8% referred, and 7.8% died. Sex showed a significant association with outcome (χ²=15.619, p<0.001, Cramer’s V=0.39), with males having higher mortality (14.3% versus 3.3%) and referral rates (23.8% versus 3.3%), while females had better treatment success (93.3% versus 61.9%). Laboratory complications were also strongly associated with outcomes (χ²=121.046, p<0.001), with multi-organ dysfunction predicting fatality and isolated prostration linked to recovery. Socio-economic status (p=0.412) and age group (p=0.179) showed no significant association.

Conclusion: Male sex and severe laboratory abnormalities are key predictors of adverse outcomes in pediatric severe malaria. Early identification of high-risk patients through sex-specific and laboratory-based risk stratification may improve clinical management and survival rates.