Factors associated with Severe malaria mortality among hospitalized children aged under five years in Eastern Province of Rwanda: A cross-sectional study using hospital records from 2017- 2021

Background Malaria remains a significant concern for children under-five in malaria-endemic regions. Rwanda’s successful efforts in malaria treatment reduced nationwide cases, but high mortality persists in the Eastern and Southern provinces. This study aimed to investigate the clinical features of severe malaria and to identify the death risk factors among under-five children in Eastern province Hospitals. Method This cross-sectional study assessed severe malaria mortality and associated factors among children aged under-five years in hospitals of Eastern Province, Rwanda, from 2017 to 2021. Data were collected from hospital records, and descriptive statistics and logistic regression were used for data analysis. Results Malaria mortality was 3.37%, mostly occurring at night (53.06%) and within 24 hours of admission (66.67%). Factors associated with severe malaria mortality included illness duration ≥ 4 days without treatment (OR = 29.22 [95% CI: 14.13–60.44]), coma (OR = 8.73 [95% CI: 8.08–38.07]), having three or more severe symptoms (OR = 5.95 [95% CI: 3.26–10.84]), high-level parasitaemia (OR = 3.71 [95% CI: 1.16–11.89]), and multi-organ complications (OR = 3.66 [95% CI: 1.04–12.84]), respiratory distress (OR = 3.33 [95% CI: 1.85-6.00]), vomiting (OR = 2.79 [95% CI: 1.49–5.20]), severe anaemia (OR = 1.85 [95% CI: 1.02–3.36]), Four day and more with illness without consultation (aOR = 38.45 [95% CI: 9.91-149.19]) and Coma (aOR = 9.61 [95% CI: 1.2-77.21]) were had greater odds of death in multivariate analysis. Conclusion In conclusion, targeted interventions are crucial to address - factors, improve healthcare-seeking behaviour, and ensure timely treatment for severe malaria in children under-five in Eastern Province, Rwanda.