ABSTRACT
To assess the epidemiology, clinical presentations, disease management, outcome and risk factors associated with severe malaria in children in four hospitals in Sudan. Follow-up prospective design was used to fulfill the objectives of the study in four hospitals: Omdurman pediatrics hospital, located in the capital [Khartoum] compared to Madani, Gadarif and Sennar hospitals located in other states. Total admission of severe malaria was 543 children representing 21% of all paediatric admissions, and 12% of malaria outpatient cases. Median age of children with severe malaria was 48 months. 93% of children with severe malaria died before the age of 9 years. Case fatality rate was 2.6%. The risk of dying because of delay was four times more than when there was no delay, 95% CI [1.5 - 14.3]. Other risks of death were severe malaria associated with coma, inability to sit or eat and hyperpyrexia. Omdurman hospital in Khartoum State in the capital, had the highest case management performance percentage compared to other regional hospitals. In view of this, it can be argued that deaths due to severe malaria could be reduced by improving health management and planning with the redistribution of resources [including consultants] at the central and regional levels and the conduct of proper training