Co-infections among Children Hospitalised with Plasmodium falciparum Malaria in Brazzaville, Republic of the Congo: Prevalence, Clinical Profile and Associated Factors

Abstract

Background: Co-infections may complicate malaria management and contribute to poorer clinical outcomes in hospitalised children. In the Republic of Congo, malaria remains the primary cause of paediatric hospitalisation, yet the epidemiology of co-infection in this context has not been systematically described. Objective: To investigate the prevalence and associated sociodemographic factors of co-infection among children hospitalised with P. falciparum malaria in Brazzaville. Methods: A retrospective hospital-based observational study was conducted in 2023 at the Brazzaville University Hospital. Children aged ≤15 years with microscopically confirmed P. falciparum malaria with or without documented co-infection or comorbidity were included. Multivariable logistic regression identified sociodemographic factors independently associated with co-infection. Results: Among 441 children enrolled (median age 48 [IQR 15-96] months), co-infection or comorbidity was identified in 16.8% (74/441). Co-infected children were more frequently younger than five years (64.9% vs 52.3%; p=0.048), originated more often from densely populated central arrondissements (41.4% vs 25.1%; p=0.008), and had longer consultation delays (4 [IQR 2-7] vs 3 [IQR 2-5] days; p=0.016). Parasitaemia was significantly higher in co-infected children (12,600 vs 6,300 parasites/µL; p< 0.001), and co-infection was more frequent among children with WHO-defined severe malaria (51.4% vs 33.5%; p=0.005). In multivariable analysis, age below five years (aOR 1.71; 95% CI 1.01-2.90) and residence in central arrondissements (aOR 1.90; 95% CI 1.12-3.23) remained independently associated with co-infection. Conclusion: These findings support systematic assessment for co-infections in hospitalised children with malaria, particularly among younger children and those living in densely populated urban areas.