Prevalence, Factors Associated and Outcomes of Severe Malaria Anaemia Among Under Five Children Admitted With Severe Malaria at Kayunga Regional Referral Hospital

Background Severe malarial anemia (SMA) is a major contributor to morbidity and mortality among children under five in malaria-endemic regions. This study aimed to determine the prevalence, associated factors, and Outcomes of SMA among children with severe malaria at Kayunga Regional Referral Hospital. Methods A hospital-based mixed study design was conducted, enrolling 321 children aged 0–5 years with severe malaria. Data were collected through structured questionnaires, clinical evaluations, and laboratory tests. Prevalence and outcomes were calculated as percentages with 95% confidence intervals (CI), while logistic regression was used to identify factors associated with SMA. Results The prevalence of SMA was 27.41% (95% CI: 22.79–32.58%). Significant predictors of SMA included age below two years (AOR = 2.57, p = 0.008), history of convulsions (AOR = 4.84, p < 0.001), splenomegaly (AOR = 2.58, p = 0.008), severe acute malnutrition (AOR = 4.40, p = 0.011), high parasitemia (+++; AOR = 8.91, p < 0.001), and delayed healthcare-seeking (AOR = 3.52, p < 0.001). Mortality was significantly higher in children with SMA (19.32%) compared to those without (0.45%, p < 0.001). Prolonged hospitalization (≥ 5 days) was more frequent in children with SMA (72.73%) than those without (19.73%, p < 0.001). Shock, hyperparasitemia (+++), and hypoglycemia were also significantly linked to increased mortality and extended hospital stays. Conclusions SMA remains a significant burden among children with severe malaria, with younger age, clinical complications, and delayed healthcare-seeking as key risk factors. Early diagnosis, timely treatment, and integrated anemia management are essential to improving survival and reducing hospital stays.