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

(2025) 24:381 Ndatumuremyi et al. Malaria Journal https://doi.org/10.1186/s12936-025-05626-w Malaria Journal Open Access RESEARCH Prevalence and factors associated with severe thrombocytopenia among hospitalized patients with malaria attending Kigeme District Hospital, Southern Province, Rwanda: cross‑sectional study Japhet Ndatumuremyi1*, Jean Marie Vianney Kagimbangabo2, Isaie Nshimiyimana3, Bizimungu Gaspard2, Jean Pierre Sendegeya1, Valens Nizeyimana4, Celine Byukusenge1 and Charles Nsanzabera5 Abstract Background Thrombocytopenia 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. Methods A 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. Results The 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. *Correspondence: Japhet Ndatumuremyi Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Ndatumuremyi et al. Malaria Journal Page 2 of 10 (2025) 24:381 Conclusion This 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. Keywords Prevalence, Factors, Thrombocytopenia Background Thrombocytopenia is a haematological finding commonly encountered in daily clinical practice from asymptomatic clinic patients to critically ill intensive care unit patients and it is defined as platelet count < 150 × 103 per µl [1] while platelet count less or equal to 50 × 103 per µl is known as severe thrombocytopenia [2]. Severe thrombocytopenia increases mortality risk in both children and adults with Plasmodium falciparum and Plasmodium vivax infections whereby patients having thrombocytopenia were over two times more likely to die from malaria than those without this infection [3]. The exact cause of thrombocytopenia among patients with malaria remains unclear yet it is believed to result from increased platelet destruction, reduced production, or both. Factors contributing to platelet depletion include immune-mediated destruction, disseminated intravascular coagulation (DIC), sequestration, oxidative stress, and malaria-induced apoptosis [4]. The prevalence of thrombocytopenia among patients with malaria varies across different regions. For instance, in India a study among 130 patients with malaria infection has shown that thrombocytopenia was present in 108 (83%) cases [5], while this haematological disorder was reported in 73% among 120 malaria positive cases in Pakistan [6]. A study in Ghana among children with malaria has shown that 33(33%) patients has thrombocytopenia while it was 67% among adult patients suffering from malaria in Ethiopia [7] and 51% among malaria cases in Sudan [8]. Several significant factors were identified that contribute to the onset of severe thrombocytopenia, including the severity of illness, drugs, organ dysfunction, sepsis, septic shock, and renal failure [9]. Although the morbidity and mortality associated with thrombocytopenia are generally low in in patients with malaria, its presence frequently indicates a poor prognosis due to its association with underlying complications. In Rwanda, there is a limited information on the magnitude of severe thrombocytopenia and its associated factors among hospitalized patients with severe malaria. Therefore, this study aims to determine the prevalence and factors associated with severe thrombocytopenia among hospitalized patients having severe malaria attending Kigeme District Hospital, Southern Province, Rwanda. Methods Stu (...truncated)