Impact of anemia on length of hospital stay among patients hospitalized for severe malaria in Brazzaville, Republic of the Congo
- 1Ambulatory Treatment Center of Brazzaville, Congo
Abstract
BackgroundSevere malaria remains a major cause of hospitalization in malaria-endemic sub-Saharan Africa, and anemia is among its most frequent severity criteria. Data on the impact of anemia on hospital length of stay (LOS) among adults with severe malaria remain limited in Central Africa. We assessed the impact of anemia on LOS among adults hospitalized for severe malaria in Brazzaville, Republic of Congo.
MethodsWe conducted a cross-sectional, descriptive, and analytic study of medical records from adult patients ([≥]18 years) diagnosed with severe malaria (WHO criteria) and admitted to four hospitals in Brazzaville between January 2020 and December 2024. We dichotomized LOS as short (<5 days) or prolonged ([≥]5 days). Multivariable logistic regression, using a backward stepwise procedure, identified factors independently associated with prolonged LOS; isolated hemoglobinuria served as the reference severity category.
ResultsAmong 523 patients hospitalized for severe malaria, 296 met the inclusion criteria. Median age was 25.5 years (IQR 20-40); 51.7% were female, and 82.1% had a low socioeconomic status. Median hemoglobin was 10.55 g/dL, and median LOS was 4 days (IQR 3-5). In multivariable analysis, prolonged LOS was independently associated with delay to consultation (aOR 1.25/day, 95% CI 1.09-1.44), isolated anemia (aOR 7.07, 1.23-40.55), convulsions (aOR 5.86, 1.81-18.97), prostration (aOR 4.42, 1.21-16.2), and impaired consciousness (aOR 4.29, 1.17-15.7). The strongest associations involved combined severity criteria: anemia with prostration (aOR 8.58), anemia with jaundice or hemoglobinuria (aOR 16.21), and impaired consciousness with anemia (aOR 33.31).
ConclusionsAnemia is a major, potentially modifiable determinant of prolonged hospitalization in adults with severe malaria, with a markedly amplified effect when combined with neurologic impairment. Early anemia screening, improved access to safe blood transfusion, and reduced delays to care could shorten hospital stays and ease the burden on health systems in this setting.
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BibTeX
@misc{ekat2026impact,
title = {{Impact of anemia on length of hospital stay among patients hospitalized for severe malaria in Brazzaville, Republic of the Congo}},
author = {M. H. Ekat and M. Amona and M. Andzi Barre and P. Bendett Lebaho and G. A. Aloumba and T. Adoua Doukaga},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.14.26365597},
url = {https://www.medrxiv.org/content/10.64898/2026.10.14.26365597v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Impact of anemia on length of hospital stay among patients hospitalized for severe malaria in Brazzaville, Republic of the Congo
AU - M. H. Ekat
AU - M. Amona
AU - M. Andzi Barre
AU - P. Bendett Lebaho
AU - G. A. Aloumba
AU - T. Adoua Doukaga
PY - 2026
DA - 2026/10/14
PB - medRxiv
DO - 10.64898/2026.10.14.26365597
UR - https://www.medrxiv.org/content/10.64898/2026.10.14.26365597v1
AB - BackgroundSevere malaria remains a major cause of hospitalization in malaria-endemic sub-Saharan Africa, and anemia is among its most frequent severity criteria. Data on the impact of anemia on hospital length of stay (LOS) among adults with severe malaria remain limited in Central Africa. We assessed the impact of anemia on LOS among adults hospitalized for severe malaria in Brazzaville, Republic of Congo. MethodsWe conducted a cross-sectional, descriptive, and analytic study of medical records from adult patients ([≥]18 years) diagnosed with severe malaria (WHO criteria) and admitted to four hospitals in Brazzaville between January 2020 and December 2024. We dichotomized LOS as short (<5 days) or prolonged ([≥]5 days). Multivariable logistic regression, using a backward stepwise procedure, identified factors independently associated with prolonged LOS; isolated hemoglobinuria served as the reference severity category. ResultsAmong 523 patients hospitalized for severe malaria, 296 met the inclusion criteria. Median age was 25.5 years (IQR 20-40); 51.7% were female, and 82.1% had a low socioeconomic status. Median hemoglobin was 10.55 g/dL, and median LOS was 4 days (IQR 3-5). In multivariable analysis, prolonged LOS was independently associated with delay to consultation (aOR 1.25/day, 95% CI 1.09-1.44), isolated anemia (aOR 7.07, 1.23-40.55), convulsions (aOR 5.86, 1.81-18.97), prostration (aOR 4.42, 1.21-16.2), and impaired consciousness (aOR 4.29, 1.17-15.7). The strongest associations involved combined severity criteria: anemia with prostration (aOR 8.58), anemia with jaundice or hemoglobinuria (aOR 16.21), and impaired consciousness with anemia (aOR 33.31). ConclusionsAnemia is a major, potentially modifiable determinant of prolonged hospitalization in adults with severe malaria, with a markedly amplified effect when combined with neurologic impairment. Early anemia screening, improved access to safe blood transfusion, and reduced delays to care could shorten hospital stays and ease the burden on health systems in this setting.
ER -