Survival Patterns and Prognostic Factors Among Children Hospitalized with Severe Malaria in Mbujimayi, Democratic Republic of the Congo: A Multicenter Cohort Study.
4 affiliations
- 1Department of Epidemiology, Disease Prevention and Control, Faculty of Public Health, Official University of Mbuji-Mayi (UOM), Mbuji-Mayi, Democratic Republic of the Congo.
- 2School of Public Health, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo.
- 3Department of Public Health, University of Kamina, Kamina, Haut-Lomami Province, Democratic Republic of the Congo.
- 4Expanded Programme on Immunization (EPI), Ministry of Health, Kinshasa, Democratic Republic of the Congo.
Abstract
Background
Severe malaria remains a major cause of mortality among children under five years of age in sub-Saharan Africa. However, data precisely describing the timing of in-hospital deaths and factors associated with time to death remain limited in the Democratic Republic of the Congo.Methods
A multicenter retrospective cohort was assembled from the medical records of children aged 0-59 months hospitalized with severe malaria in the ten General Referral Hospitals of Mbujimayi between January 1 and December 31, 2025. Exhaustive sampling was applied. Time zero was the date and time of admission. Survival was estimated using the Kaplan-Meier method. A Cox model was specified with age as a continuous variable (per 12-month increase) and then assessed using robust variance clustered by hospital. Deviations from proportional hazards were assessed using Schoenfeld residuals and an extended Cox analysis. Blood transfusion, for which the time of administration was unavailable, was excluded from the main prognostic model.Results
Among 674 children included, 112 died, yielding an in-hospital case-fatality rate of 16.6%. The median admission-to-death time among children who died was 28.6 hours. Estimated survival was 93.0% at 24 hours, 88.3% at 48 hours, and 86.1% at 72 hours. Median survival was not reached within the 28-day horizon, and the restricted mean survival time to day 28 was 22.41 days. In the analysis using robust variance clustered by hospital, each additional 12 months of age was associated with a lower average hazard of death (HR 0.756; 95% CI: 0.608-0.940; p=0.012). Coma (HR 2.700; 95% CI: 1.908-3.820; p<0.001), acute pulmonary edema (HR 2.002; 95% CI: 1.028-3.898; p=0.041), an admission delay >48 hours (HR 2.605; 95% CI: 1.575-4.308; p<0.001), and nighttime admission (HR 1.746; 95% CI: 1.246-2.446; p=0.001) were associated with a higher hazard of death. These estimates are interpreted as prognostic associations rather than causal effects.Conclusion
In-hospital mortality was strongly concentrated within the first 72 hours. Age, coma, acute pulmonary edema, delayed admission, and nighttime admission were associated with time to death after accounting for the multicenter structure. External validation and more complete biological data are needed before these findings can be used for individual risk stratification.
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BibTeX
@article{banza2026survival,
title = {{Survival Patterns and Prognostic Factors Among Children Hospitalized with Severe Malaria in Mbujimayi, Democratic Republic of the Congo: A Multicenter Cohort Study.}},
author = {Rodrick Tshiunza Banza and Simon Ilunga Kandolo and Michel Kabamba Nzaji},
journal = {Journal of multidisciplinary healthcare},
year = {2026},
month = oct,
doi = {10.2147/jmdh.s640626},
url = {https://europepmc.org/article/MED/42968744},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Survival Patterns and Prognostic Factors Among Children Hospitalized with Severe Malaria in Mbujimayi, Democratic Republic of the Congo: A Multicenter Cohort Study.
AU - Rodrick Tshiunza Banza
AU - Simon Ilunga Kandolo
AU - Michel Kabamba Nzaji
PY - 2026
DA - 2026/10/30
JO - Journal of multidisciplinary healthcare
DO - 10.2147/jmdh.s640626
UR - https://europepmc.org/article/MED/42968744
AB - Background Severe malaria remains a major cause of mortality among children under five years of age in sub-Saharan Africa. However, data precisely describing the timing of in-hospital deaths and factors associated with time to death remain limited in the Democratic Republic of the Congo.Methods A multicenter retrospective cohort was assembled from the medical records of children aged 0-59 months hospitalized with severe malaria in the ten General Referral Hospitals of Mbujimayi between January 1 and December 31, 2025. Exhaustive sampling was applied. Time zero was the date and time of admission. Survival was estimated using the Kaplan-Meier method. A Cox model was specified with age as a continuous variable (per 12-month increase) and then assessed using robust variance clustered by hospital. Deviations from proportional hazards were assessed using Schoenfeld residuals and an extended Cox analysis. Blood transfusion, for which the time of administration was unavailable, was excluded from the main prognostic model.Results Among 674 children included, 112 died, yielding an in-hospital case-fatality rate of 16.6%. The median admission-to-death time among children who died was 28.6 hours. Estimated survival was 93.0% at 24 hours, 88.3% at 48 hours, and 86.1% at 72 hours. Median survival was not reached within the 28-day horizon, and the restricted mean survival time to day 28 was 22.41 days. In the analysis using robust variance clustered by hospital, each additional 12 months of age was associated with a lower average hazard of death (HR 0.756; 95% CI: 0.608-0.940; p=0.012). Coma (HR 2.700; 95% CI: 1.908-3.820; p<0.001), acute pulmonary edema (HR 2.002; 95% CI: 1.028-3.898; p=0.041), an admission delay >48 hours (HR 2.605; 95% CI: 1.575-4.308; p<0.001), and nighttime admission (HR 1.746; 95% CI: 1.246-2.446; p=0.001) were associated with a higher hazard of death. These estimates are interpreted as prognostic associations rather than causal effects.Conclusion In-hospital mortality was strongly concentrated within the first 72 hours. Age, coma, acute pulmonary edema, delayed admission, and nighttime admission were associated with time to death after accounting for the multicenter structure. External validation and more complete biological data are needed before these findings can be used for individual risk stratification.
SN - 1178-2390
ER -