Evaluation of impact of COVID-19 pandemic on the burden and pattern of severe malaria in Nigerian children





Children, COVID-19, Cerebral, Severe malarial anaemia


Background: Malaria is an infectious disease caused by the protozoan Plasmodium, accounting for 36% of under-five mortality. About 4.5% of all malaria-infected children reported at least one symptom of severe malaria, with worsening outcome. COVID-19 and malaria shared similar clinical presentation in children this similarity may lead to delay in initiation of treatment for malaria, with progression from uncomplicated to severe forms and consequently high mortality. Thus, we set out to study the extent COVID-19 impacted on the burden and pattern of severe malaria.

Methods: It was a retrospective study of all the children admitted into the children’s emergency room severe malaria, from March 2018 to February 2022. The data collected included the total number of admissions within the period, the month and year of admission, age, gender, the component of severe malaria that was the final diagnosis and outcome of management. Data were analysed using NCSS 9 statistical software.

Results: There were 4761 admissions within the study period: males were 54.7%, subjects 1-<60 months were 60.5% and pre COVID-19 period were 63.7%. The prevalence rates of severe malaria in CHER were 2.6%. Among those with severe malaria, the case fatality rate was 10.7%. Severe malarial anemia was the most common accounting for 49.2% and has predilection for the younger age. Cerebral malaria was predominantly diagnosed during the COVID-19 period.

Conclusions: The prevalence of severe malaria was 2.6% and severe malaria anaemia was the most common mode of presentation while cerebral malaria was diagnosed more during the COVID-19 period.


World Health Organization. World malaria report 2021. Available from: https://www.who.int/publications/i/item/9789240040496. Accessed on 21 October 2022.

Ezeonwu B, Chima O, Oguonu T, Ikefuna A, Nwafor I. Morbidity and mortality pattern of childhood illnesses seen at the children emergency unit of federal medical center, Asaba. Ann Med Health Sci Res. 2014;4(Suppl 3):239-44.

Nigeria Federal Ministry of Health, National Malaria Control Programme. Strategic plan 2009-2013: “a road map for malaria control in Nigeria”, abridged version. Abuja: Yaliam Press Ltd, Federal Ministry of Health; 2009.

Severe Malaria Criteria, Features and Definition. Available from: https://www.severemalaria.org/ severe-malaria/severe-malaria-criteria-features-definition. Accessed on 10 July 2021.

Orimadegun AE, Fawole O, Okereke JO, Akinbami FO, Sodeinde O. Increasing burden of childhood severe malaria in a Nigerian tertiary hospital: implication for control. J Trop Pediatr. 2007;53:185-9.

Edelu BO, Ndu IK, Igbokwe OO, Iloh ON. Severe falciparum malaria in children in Enugu, Southeast Nigeria. Niger J Clin Pract. 2018;21:1349-55.

Jalo I, Warnow IE, Aliu R, Shina HK. Burden, clinical manifestation and outcome of severe malaria in children at a tertiary hospital in Northeast Nigeria. Int J Contemp Pediatr. 2020;7:1659-64.

Taylor C, Namaste SM, Lowell J, Useem, Yé Y. Estimating the fraction of severe malaria among malaria-positive children: analysis of household surveys in 19 malaria-endemic countries in Africa. Am J Trop Med Hyg. 2021;104:1375-82.

Dzeing‑Ella A, Nze Obiang PC, Tchoua R, Planche T, Mboza, B, Mbounja M, et al. Severe falciparum malaria in Gabonese children: Clinical and laboratory features. Malar J. 2005;4:1.

Mockenhaupt FP, Ehrhardt S, Burkhardt J, Bosomtwe SY, Laryea S, Anemana SD, et al. Manifestation and outcome of severe malaria in children in Northern Ghana. Am J Trop Med Hyg. 2004;71:167‑72.

Al‑Taiar A, Jaffar S, Assabri A, Al-Habori M, Azazy A, Al-Mahdi N, et al. Severe malaria in children in Yemen: Two site observational study. BMJ. 2006;333:827.

Ajetunmobi WA, Orimadegun AE, Brown BJ, Afolabi NK, Olabiyi FA, Anetor JI, et al. Haemoglobinuria among children with severe malaria attending tertiary care in Ibadan, Nigeria. Malar J. 2012;11:336.

World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19, 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Accessed on 22 August 2020.

Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020;4(5);E10-1.

Mekaoui N, Razine R, Bassat Q, Benjelloun BS, Karboubi L. The effect of covid-19 on paediatric emergencies and admissions in Morocco: cannot see the forest for the trees? J Trop Pediatr. 2021;67(3):fmaa046.

Heuschen AK, Abdul-Mumin A, Adokiya M, Lu G, Jahn A, Razum O, et al. Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: a retrospective analysis of routine surveillance data. Malar J. 2020;21:149.

Buonsenso D, Iodice F, Cinicola B, Raffaelli F, Sowa S, Ricciardi W. Management of malaria in children younger than 5 years old during coronavirus disease 2019 pandemic in Sierra Leone: a lesson learned? Front Pediatr. 2021;8:587638.

Correia MJ, Frade L, Guerreiro R, Araujo I, Baptista T, Fonseca C, et al. A patient with severe malaria and COVID-19: how do you tell the difference between these infections? Eur J Case Rep Intern Med. 2020;7:002007.

Junaedi M, Katu S, Ilyas M, Daud N, Saleh S, Rasyid H, et al. Case report: COVID-19 and severe malaria co-infection. Eur J Mol Clin Med. 2020;7(8):961-8.

Imoudu IA, Ahmad H, Yusuf MO, Umara T, Oloriegbe YY. Clinical profile and outcome of paediatric severe malaria in a North-Eastern Nigeria Tertiary Hospital. Int J Trop Dis Health. 2017;28:1-9.

Patel H, Dunican C, Cunnington AJ. Predictors of outcome in childhood Plasmodium falciparum malaria. Virulence. 2020;11:199-221.

World Health Organization. Prevalence of anaemia in children aged 6-59 months. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-children-under-5-years-(-). Accessed on 22 November 2022.

World Health Organization. Nutritional anaemias: tools for effective prevention and control 2017. Available from: https://www.who.int/publications/i/ item/9789241513067. Accessed on 22 November 2022.

Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. The impact of the COVID-19 pandemic on outpatient visits: a rebound emerges. To the Point (blog). Commonwealth Fund. 2020. Available from: https://doi.org/10.26099/ds9e-jm36. Accessed on 22 November 2022.




How to Cite

Bamidele, O. C., Ezeonwu, B. U., Ajaegbu, O. C., Joseph, U. C. A., Adaramola, T. S., Anazor, C. V., Abonyi, L. E., Nwafor, I. O., & Okolo , A. A. (2023). Evaluation of impact of COVID-19 pandemic on the burden and pattern of severe malaria in Nigerian children. International Journal Of Community Medicine And Public Health, 10(2), 604–611. https://doi.org/10.18203/2394-6040.ijcmph20230211



Original Research Articles