Using sentinel surveillance system data to characterize severe malaria illness and quality of malaria case management among hospitalized patients in Kenya, 2017-2024

Background : In Kenya, limited clinical data on hospitalized malaria patients restricts insights into disease severity and care quality. Using data from the Integrated Facility-based Surveillance (IFBS) system—a sentinel surveillance platform for febrile illnesses across twelve facilities—we assessed risk factors for severe illness and mortality, diagnostic accuracy of microscopy, and adherence to severe malaria treatment guidelines. Methods : We analyzed IFBS data obtained from June 2017 to July 2024 using bivariable logistic regression to identify factors linked to severe illness and deaths. Microscopy results were compared with PCR results to assess diagnostic concordance. We also evaluated whether patients received parasitological confirmation before treatment and if severe cases received IV artesunate followed by artemether-lumefantrine (AL), per standard guidelines. Results : Among 8,487 inpatients, 2,197 (25.9%) tested positive for malaria; among malaria cases, 713 (32.5%) had severe disease and 16 (0.7%) died. Severe illness and deaths were associated with age under one year and delayed care-seeking. Positive routine microscopy was PCR negative in 21% of patients. Only 15% of severe cases were documented to have received both IV artesunate and AL, while 17% received IV quinine. Discussion : Risk factors associated with severe illness and mortality included young age < 1 as well as modifiable risk factors that suggested delayed care seeking. Despite IFBS data reliance on chart reviews, findings reveal critical gaps in diagnostic accuracy and adherence to treatment protocols for severe malaria. Trial registration: N/A