Malaria, a major public health problem [1], is an endemic for which many resolutions have been taken: that of Abuja: “to roll back malaria” [2], the United Nations Millennium Declaration (UN): building together a more secure, prosperous and equitable world [3], the Millennium Development Goals (MDGs) [3] and the Sustainable Development Goals for the eradication of malaria in many countries by 2030. In 2019, 229 million cases of malaria were recorded worldwide, including 213 million in Africa. There were 409,000 deaths and, children under five were the most affected [4]. The severe forms are the fifth leading cause of death from infectious diseases in the world and second in Africa [5]. The high prevalence and relative mortality are variable: 18% - 67.8% in the Democratic Republic of Congo (DRC) [6], 21.7% in Senegal [7], 55.8% in Mali [8] and 53 % in Niger [9] with respectively 4%, 24%, 10%, and 3.6% of deaths.

In Congo, the prevalence of severe forms of malaria was 11.2% in 2016 and mortality 6.5% [10]. While African populations continue to pay the heavy price for severe malaria [5], the Covid-19 pandemic risks are hampering the efforts of health systems around the world [11]. Our study aimed to assess the impact of the covid-19 pandemic on severe childhood malaria at the University Hospital of Brazzaville and the objectives: determine the frequency of severe malaria; describe the clinical, para-clinical, therapeutic and evolutionary aspects; identify the factors associated with the death of a child hospitalized for severe malaria during the Covid-19 pandemic period and report the indicators of its impact on severe childhood malaria in Brazzaville.

We carried out a quasi-experimental intervention/non-intervention study between March and October 2020, i.e. in eight months. Three of the four pediatric departments of the University Hospital of Brazzaville: grandchildren pediatrics, infant pediatrics and that of Pediatric Intensive Care (ICU) formed the framework of the study. The target population, made up of children aged three months to 15 years hospitalized in the aforementioned services was divided into two groups: group 1 or “intervention”, that of children hospitalized between March and October 2020 and group 2 or “control”. That of children hospitalized between January and August 2015, eight months [10].

Children aged three months to 15 years hospitalized in the aforementioned services whose discharge diagnosis included, among other things, the item “severe malaria” [12] were included. Severe malaria was defined by the World Health Organization criteria [13]. This was a simple and consecutive probability sampling taking into account medical records and service registers. The sample size of group 2 “control” was that of the study carried out in the same wards in children admitted for “severe malaria” [10]. That of group 1 “intervention” was calculated from the SCHWARTZ formula. The minimum sample size was set at 153 patients.

The sample size of group 1 “control” corresponded to that of the studycarried out in the same services by Okoko [10], on “severe malaria” in children at the Brazzaville UniversityHospital: 382 patients. For group 2 “intervention” the sample size wascalculatedfrom the formula of Daniel Schwartz taking intoaccount a previousstudy by Okoko [10].

N = P ( 1 − P ) . ( Zα ) 2 / d 2

P: Expected proportion of subjectspresenting the studied variable (severe malaria in our case);

Zα: Standardizedsignificancelevel = 1.96;

d²: Imprecisiondeviation = 0.05.

Severe malaria represented 11.2% of all children hospitalized during this studyperiod. Thus, N = 0.112 (1 − 0.112) (1.96) 2/(0.05) 2 = 152.83 N ≈ 153 is the minimum size of the sampleallowing a statisticalanalysis.

The study variables were twofold. Those relating to the child: the mode and reason for admission, the consultation time, the antecedents, the functional and examination signs, the thick gout hematozoicsmear, the rapid diagnostic test (RDT), the Complete blood count (CBC), blood sugar, creatinemia, diagnosis, treatment and pattern. Those relating to parents: age, sex, marital status, socio-economic and cultural level and occupation.

The data were collected using a pre-established survey form developed and completed for this purpose. The antimalarials used were: artesunate 2.4 mg/kg for a weight greater than 20 kg and 3 mg/kg when it was less than 20 kg intravenous (IV) or intramuscular (IM) at H0, H12, H24 then a taken per 24 hours from day 2 to day 5; quinine base 20 mg/kg as a loading dose, then 10 mg/kg every eight hours. A relay by the oral route was authorized when the clinical state was considered stable. In this case, the artemether-lumefantrine combination was used after at least three days of parenteral treatment. The maximum duration of treatment was seven days. The other therapeutic means consisted of administration of 10% hypertonic glucose serum 50 mL/kg, diazepam 0.5 mg/kg intra-rectally, phenobarbital 10 to 15 mg/kg IV, hypertonic glucose serum 50% 1 mL/kg, the erythrocyte pellet using Molison’s formula (amount = 3 × weight [desired Hb-diseased Hb]) and furosemide 1 - 2 mg/kg.

In all cases, the criteria for cure were the achievement of apyrexia and the denial of thick gout. The other criteria, depending on the clinical form were the recovery of consciousness, the re-coloring of the mucous membranes, the integuments and the appearance of the urine, the resumption of food and walking, a hemoglobin level within the limits of normal and normalization of renal function.

As Covid-19 continues to occupy the political health agenda in many countries around the world, so does its impact on certain diseases which is becoming apparent. Malaria is one of them. The general objective of this study was: to assess the impact of the Covid-19 pandemic on severe childhood malaria in Brazzaville and specifically: to determine its frequency, to describe the nosological varieties, to assess the evolutionary profile, to identify the factors associated with deaths during the period of the Covid-19 pandemic and report the indicators of the impact of the Covid-19 pandemic on severe malaria in children hospitalized at the Brazzaville CHU by referring to a previous study [10] of which the methodology was identical to ours. The high mortality, attributable to severe malaria despite the efforts made for its reduction by the international community guided our choice, which was reinforced by the cry of alarm from the WHO which feared that the Covid-19 pandemic would be wiped out. The benefits obtained over the last twenty years by the health systems of the various countries [11]. To achieve our objectives, a cross-sectional study carried out in the largest hospital in Brazzaville seemed to us the ideal setting. However, the conduct of the study was a source of bias, including those relating to its implementation during the period of the health emergency coupled with the confinement of the population. This study presents in its implementation somelimitations, relating to its duration, namely eight months, its implementation during a period of confinement, state of health emergency, source of recruitment bias.

The morbidity and mortality linked to severe childhood malaria have doubled in Brazzaville since the advent of the Covid-19 pandemic. The anemic and neurological forms are the most observed. Delayed consultation, fever, repeated convulsions, pallor, respiratory distress, sickle cell anemia, thrombocytopenia and hypoglycemia are associated with death. Mortality from severe malaria is twice as high during the Covid-19 pandemic. It seems imperative for health systems to ensure that a balance is maintained between the management of the Covid-19 pandemic and that of other worrying health problems, including malaria.

The authors declare no conflicts of interest regarding the publication of this paper.

Engoba, M., Gnakingue, A.N.O., Nianga, B.B., Goma, C.E., Batchi-Bouyou, A.L., Okoko, A.R. and Mo- yen, G.M. (2021) Impact of the Covid-19 Pandemic on Severe Childhood Malaria at the University Hospital of Brazzaville. Open Journal of Pediatrics, 11, 301-312. https://doi.org/10.4236/ojped.2021.112028