Clinical, therapeutic, and evolutionary characteristics of severe pediatric malaria: A retrospective study at the Kangaba Reference Health Center (2020 to 2023)

Severe malaria remains a major cause of morbidity and mortality among children in sub-Saharan Africa. This study aims to describe the clinical, therapeutic, and evolutionary profiles of severe malaria in Kangaba, Mali. A cross-sectional study was conducted in the pediatric department of Kangaba Reference Health Center between 2020 and 2023 to collect data on severe malaria. A case report form was used for data collection, and the Statistical Package for Social Sciences (SPSS) for data analysis. Variables studied included clinical signs, clinical phenotypes, treatment, outcome, and cost of care. Descriptive analysis was conducted using frequencies and percentages. Malaria was diagnosed in all study participants using thick blood smear microscopy. A total of 1522 cases were included. The highest annual incidence of severe malaria was recorded in 2022 (37.3%). Monthly analysis showed that this peak occurred in October 2020 and 2021, in November 2022, and in August 2023, reflecting seasonal and interannual variability. The most frequent symptoms were fever (57.4%), convulsions (54.8%), and pallor (49.7%). Neurological signs accounted for 74.8% of severe cases. The predominant clinical phenotypes were cerebral malaria (55.9%) and severe anemia (32.3%). Injectable artesunate was used in 98.3% of cases, with oral artemisinin-based combination therapy (ACT) follow-up in 84.9%. The cure rate was 87%, with mortality at 4%. The average cost of care was 19.887 ± 5.526 FCFA. Severe malaria remains a major public health problem among children in Kangaba, with incidence peaks varying by season and year. The disease mainly presents cerebral malaria and severe anemia, with neurological symptoms being the most frequent. Although treatment with injectable artesunate followed by oral ACT is highly effective Key words: Severe malaria, children, characteristics, Mali.