贫血对刚果共和国布拉柴维尔重症疟疾住院患者住院时长的影响

Abstract

Background: Severe malaria remains a major cause of hospitalization in malaria-endemic sub-Saharan Africa, and anemia is among its most frequent severity criteria. Data on the impact of anemia on hospital length of stay (LOS) among adults with severe malaria remain limited in Central Africa. We assessed the impact of anemia on LOS among adults hospitalized for severe malaria in Brazzaville, Republic of Congo. Methods: We conducted a cross-sectional, descriptive, and analytic study of medical records from adult patients (≥18 years) diagnosed with severe malaria (WHO criteria) and admitted to four hospitals in Brazzaville between January 2020 and December 2024. We dichotomized LOS as short (<5 days) or prolonged (≥5 days). Multivariable logistic regression, using a backward stepwise procedure, identified factors independently associated with prolonged LOS; isolated hemoglobinuria served as the reference severity category. Results: Among 523 patients hospitalized for severe malaria, 296 met the inclusion criteria. Median age was 25.5 years (IQR 20–40); 51.7% were female, and 82.1% had a low socioeconomic status. Median hemoglobin was 10.55 g/dL, and median LOS was 4 days (IQR 3–5). In multivariable analysis, prolonged LOS was independently associated with delay to consultation (aOR 1.25/day, 95% CI 1.09–1.44), isolated anemia (aOR 7.07, 1.23–40.55), convulsions (aOR 5.86, 1.81–18.97), prostration (aOR 4.42, 1.21–16.2), and impaired consciousness (aOR 4.29, 1.17–15.7). The strongest associations involved combined severity criteria: anemia with prostration (aOR 8.58), anemia with jaundice or hemoglobinuria (aOR 16.21), and impaired consciousness with anemia (aOR 33.31). Conclusions: Anemia is a major, potentially modifiable determinant of prolonged hospitalization in adults with severe malaria, with a markedly amplified effect when combined with neurologic impairment. Early anemia screening, improved access to safe blood transfusion, and reduced delays to care could shorten hospital stays and ease the burden on health systems in this setting.

Competing Interest Statement

The authors have declared no competing interest.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Research Ethics Committee for Health Sciences (CERSSA) was consulted because the study reviewed existing medical records, CERSSA determined that formal approval was not required, provided patient anonymity was maintained

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Yes

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The datasets analyzed during the current study are available from the corresponding author upon reasonable request (deidentified participant data, data dictionary).