Factors Associated with Hospitalizations Due to Severe Malaria in the Non-Endemic Brazilian Region: A Case-Control Study in the Extra-Amazon Region from 2011 to 2019

Background Malaria is an acute infectious disease with its occurrence in Brazil concentrated in the Amazon region. But it is in the extra-amazon region where the lethality is higher. Therefore, this study aimed to analyze factors associated with malaria hospitalizations in the extra-Amazon region of Brazil. Methods A case-control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria cases without hospitalization. Probabilistic record linkage techniques were employed, and associations were analyzed using multiple logistic regression with a 0.05 significance level. Results There were 2137 hospitalizations, and the risk factors identified were people with: Black or mixed-race ethnicity, low education, infected in the Amazon region or abroad, or infected by P. falciparum or mixed infections, and delayed treated. Active case detection was found as a protective factor. Conclusions The results highlight a need for reinforcing timely diagnosis and treatment, while aiming at health equity measures. Strengthening diagnostic networks and effective communication strategies is critical to reducing complications and achieving malaria deaths elimination goals by 2030.