RESUMO
Background Severe malaria is a key global public health issue, particularly in Sub-Saharan Africa, which accounts for over 80% of global malaria deaths. Rwanda has experienced about 11-fold annual increase in reported malaria cases since 2012 to 2016. Severe malaria accounted for 13,092 cases in 2015 to 17,248 cases in 2016. Objective To determine factors associated with severe malaria among patients under reference to Gihundwe and Mibilizi Hospitals. Methods A cross-sectional study that included 228 febrile patients diagnosed with malaria at Gihundwe and Mibilizi Hospitals was conducted. Data were collected from patients' files. Logistic regressions were computed to establish determinants of severe anemia. Odds ratio (OR), 95% confidence level (CI) and p-value were reported. Results The proportion of severe malaria was 64.03%. The multivariable logistic regression analysis showed that patients under five years (aOR = 8.169; 95%CI = 3.646- 18.304); being males (aOR = 2.539; 95%CI = 1.299-4.965); farmers (aOR = 2.757; 95%CI = 1.339-5.678) and limited access to health facilities (aOR = 2.740: 95%CI = 1.038-7.232) were the main factors associated with severe malaria. Conclusion Severe malaria was high with various associated factors. There is a need to strengthen malaria control and prevention interventions for young children, men and farmers. Furthermore, beside public health interventions, health facilities should be accessible to people residing in malaria endemic areas.