Prevalence and factors associated with severe thrombocytopenia among hospitalized patients with malaria attending Kigeme District Hospital, Southern Province, Rwanda: cross-sectional study.

backgroundThrombocytopenia is a common haematological abnormality in malaria patients, increasing the risk of mortality in both children and adults with Plasmodium falciparum and Plasmodium vivax infections. In Rwanda, data on the prevalence and associated factors of severe thrombocytopenia in malaria patients are limited. This study aimed to determine the prevalence and factors associated with severe thrombocytopenia among hospitalized patients with malaria attending Kigeme District Hospital, Southern Province, Rwanda.

methodsA cross-sectional study was conducted from December 2023 to November 2024 among malaria patients at Kigeme District Hospital, Rwanda. Using simple random sampling, 124 patients were selected while ensuring confidentiality throughout data collection, analysis, and reporting. Data were gathered via a structured form in Kobo Toolbox and later processed in Microsoft Excel. Information on demographic, clinical characteristic and laboratory investigations considered were those collected during the time of patients admission to the hospital. Binary logistic regression was employed to assess associations, with variables showing a p-value < 0.05 in bivariate analysis included in the multivariable model. Adjusted odds ratios (AOR) with 95% confidence intervals were computed, and statistical significance was set at p-value < 0.05.

resultsThe study has shown that severe thrombocytopenia was 27.4% among patients with malaria. Factors associated with severe thrombocytopenia among patients with malaria were age group less or equal to 5 years old (AOR = 5.17, 95%CI 1.674-16.259, p = 0.004), type infecting Plasmodium species (AOR = 3.4, 95%CI 2.41-8.3, p = 0.04) positive C-Reactive Protein (AOR = 3.45, 95%CI 2.23-3.56, P = 0.045), jaundice (AOR = 2.875, 95% CI 1.36-26.5, p = 0.045), epistaxis (AOR = 1.84, 95% CI 1.73-2.43, p = 0.042), high serum urea (AOR = 1.73, 95% CI 1.23-1.83, p = 0.001). On the other hand, patients with coma status (cerebral malaria) (AOR = 0.189, 95% CI 0.137-0.985, p = 0.028, Delay to seek medical care (AOR = 0.393, 95% CI 0.043-1.125, p = 0.082) were less likely associated with severe thrombocytopenia.

conclusionThis cross-sectional study found a 27.4% prevalence of severe thrombocytopenia in malaria patients. Key associated factors included less or equal to 5 years old, positive C-reactive protein, type of Plasmodium infecting species, jaundice, epistaxis, and high serum urea levels, while cerebral malaria linked to a lower likelihood of thrombocytopenia. This highlight the need for early identification severe thrombocytopenia among severe malaria patients who are at high likelihood suffering severe thrombocytopenia. Further longitudinal studies are recommended to better understand the predictive value of these factors and their role in guiding clinical management.