Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019
Abstract Background Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe...
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2025-07-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-025-05357-y |
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| author | Anderson Coutinho da Silva Elisabeth Carmem Duarte Paola Barbosa Marchesini Giselle Maria Rachid Viana Walter Massa Ramalho Klauss K. S. Garcia |
| author_facet | Anderson Coutinho da Silva Elisabeth Carmem Duarte Paola Barbosa Marchesini Giselle Maria Rachid Viana Walter Massa Ramalho Klauss K. S. Garcia |
| author_sort | Anderson Coutinho da Silva |
| collection | DOAJ |
| description | Abstract Background Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe malaria) in the extra-Amazon Region, in order to prevent deaths. Methods A case–control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria notifications without hospitalization. Probabilistic record linkage techniques were employed, and associations were analysed using multiple logistic regression with a 0.05 significance level. Results The main risk factors identified were: Black or mixed-race ethnicity (OR = 1.22; 95% CI 1.04–1.43), low education (elementary school OR = 2.21; 95% CI 1.78–2.75 or high school OR = 1.72; 95% CI 1.39–2.13), infection outside the extra-Amazon Region (Amazon Region OR = 1.50; 95% CI 1.15–1.96 or abroad OR = 1.72; 95% CI 1.28–2.32), high parasite count (501 to 10,000/mm3 OR = 1.51; 95% CI 1.27–1.80, 10,001 to 100,000/mm3 OR = 1.77; 95% CI 2.87–1.96 or higher than 100,000/mm3 OR = 3.15; 95% CI 2.20–4.50) and delayed treatment (after 3–7 days symptoms onset OR = 1.74; 95% CI 1.36–2.24 or 8 days or more OR = 2.08; 95% CI 1.62–2.66). Active case detection was a protective factor (OR = 0.65; 95% CI 0.54–0.78). Conclusions Delayed treatment remains a key factor in the occurrence of severe malaria, leading to high parasitaemia and revealing inequalities in access to healthcare based on socioeconomic differences. Travel to the Amazon Region or other countries also poses a challenge, requiring strengthened traveller health strategies and increased surveillance awareness to promptly suspect and identify cases. |
| format | Article |
| id | doaj-art-2fe54a616c3140648cb46a2cee77e40f |
| institution | Kabale University |
| issn | 1475-2875 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj-art-2fe54a616c3140648cb46a2cee77e40f2025-08-20T03:42:34ZengBMCMalaria Journal1475-28752025-07-0124111310.1186/s12936-025-05357-yFactors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019Anderson Coutinho da Silva0Elisabeth Carmem Duarte1Paola Barbosa Marchesini2Giselle Maria Rachid Viana3Walter Massa Ramalho4Klauss K. S. Garcia5Center of Tropical Medicine, University of BrasiliaCenter of Tropical Medicine, University of BrasiliaHealth Secretariat of Health and Environmental Surveillance, Ministry of HealthEvandro Chagas Institute, Ministry of HealthCenter of Tropical Medicine, University of BrasiliaCenter of Tropical Medicine, University of BrasiliaAbstract Background Malaria is infectious disease with low occurrence in Brazil extra-Amazon Region. Despite this, higher lethality is observed in this region compared to the country's endemic area. Therefore, this study aimed to analyse factors associated with malaria hospitalizations (severe malaria) in the extra-Amazon Region, in order to prevent deaths. Methods A case–control design was used, utilizing data from the Brazilian Notifiable Diseases Information System (Sinan) and hospitalization records from the Unified Health System (SIH/SUS) from 2011 to 2019. Cases comprised hospitalized malaria patients, while controls included reported malaria notifications without hospitalization. Probabilistic record linkage techniques were employed, and associations were analysed using multiple logistic regression with a 0.05 significance level. Results The main risk factors identified were: Black or mixed-race ethnicity (OR = 1.22; 95% CI 1.04–1.43), low education (elementary school OR = 2.21; 95% CI 1.78–2.75 or high school OR = 1.72; 95% CI 1.39–2.13), infection outside the extra-Amazon Region (Amazon Region OR = 1.50; 95% CI 1.15–1.96 or abroad OR = 1.72; 95% CI 1.28–2.32), high parasite count (501 to 10,000/mm3 OR = 1.51; 95% CI 1.27–1.80, 10,001 to 100,000/mm3 OR = 1.77; 95% CI 2.87–1.96 or higher than 100,000/mm3 OR = 3.15; 95% CI 2.20–4.50) and delayed treatment (after 3–7 days symptoms onset OR = 1.74; 95% CI 1.36–2.24 or 8 days or more OR = 2.08; 95% CI 1.62–2.66). Active case detection was a protective factor (OR = 0.65; 95% CI 0.54–0.78). Conclusions Delayed treatment remains a key factor in the occurrence of severe malaria, leading to high parasitaemia and revealing inequalities in access to healthcare based on socioeconomic differences. Travel to the Amazon Region or other countries also poses a challenge, requiring strengthened traveller health strategies and increased surveillance awareness to promptly suspect and identify cases.https://doi.org/10.1186/s12936-025-05357-yMalariaSevere malariaHospitalizationsHospital admissionsExtra-Amazon RegionEpidemiological surveillance |
| spellingShingle | Anderson Coutinho da Silva Elisabeth Carmem Duarte Paola Barbosa Marchesini Giselle Maria Rachid Viana Walter Massa Ramalho Klauss K. S. Garcia Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019 Malaria Journal Malaria Severe malaria Hospitalizations Hospital admissions Extra-Amazon Region Epidemiological surveillance |
| title | Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019 |
| title_full | Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019 |
| title_fullStr | Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019 |
| title_full_unstemmed | Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019 |
| title_short | Factors associated with hospitalizations due to severe malaria in the non-endemic Brazilian region: a case–control study in the extra-Amazon Region from 2011 to 2019 |
| title_sort | factors associated with hospitalizations due to severe malaria in the non endemic brazilian region a case control study in the extra amazon region from 2011 to 2019 |
| topic | Malaria Severe malaria Hospitalizations Hospital admissions Extra-Amazon Region Epidemiological surveillance |
| url | https://doi.org/10.1186/s12936-025-05357-y |
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