Monkoti Manzi MG, Nsibu C, Bodi J, Jouvet P. Severe malaria-bacterial sepsis co-infection among critically ill children admitted to pediatric emergency departments in Kinshasa. World J Clin Pediatr 2026; 15(3): 119162 [DOI: 10.5409/wjcp.119162]
Corresponding Author of This Article
Mamy-Gloire Monkoti Manzi, MD, Lecturer, Department of Pediatric, University Clinics of Kinshasa, University Avenue, Lemba, Kinshasa 123, Congo. gloiremonkoti@gmail.com
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Pediatrics
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Monkoti Manzi MG, Nsibu C, Bodi J, Jouvet P. Severe malaria-bacterial sepsis co-infection among critically ill children admitted to pediatric emergency departments in Kinshasa. World J Clin Pediatr 2026; 15(3): 119162 [DOI: 10.5409/wjcp.119162]
World J Clin Pediatr. Sep 9, 2026; 15(3): 119162 Published online Sep 9, 2026. doi: 10.5409/wjcp.119162
Severe malaria-bacterial sepsis co-infection among critically ill children admitted to pediatric emergency departments in Kinshasa
Mamy-Gloire Monkoti Manzi, Celestin Nsibu, Joseph Bodi, Philippe Jouvet
Mamy-Gloire Monkoti Manzi, Celestin Nsibu, Joseph Bodi, Department of Pediatric, University Clinics of Kinshasa, Kinshasa 123, Congo
Mamy-Gloire Monkoti Manzi, Celestin Nsibu, Joseph Bodi, Department of Pediatric, University of Kinshasa, Kinshasa 123, Congo
Philippe Jouvet, Department of Pediatric, Sainte-Justine University Hospital, Montreal Montreal H3T 1C5, Quebec, Canada
Author contributions: Monkoti Manzi MG and Nsibu C designed the study; Monkoti Manzi MG, Nsibu C, and Bodi J collected the data; Monkoti Manzi MG and Jouvet P analyzed the data; Monkoti Manzi MG drafted the manuscript; Nsibu C, Bodi J, and Jouvet P critically revised the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of School of Public Health, University of Kinshasa, Democratic Republic of Congo, approval No. ESP/CE/047/14.
Informed consent statement: Parents or legal guardians were informed of the use of anonymized clinical data for research purposes, in accordance with local ethical standards.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. The data are not publicly available due to ethical and confidentiality considerations.
Corresponding author: Mamy-Gloire Monkoti Manzi, MD, Lecturer, Department of Pediatric, University Clinics of Kinshasa, University Avenue, Lemba, Kinshasa 123, Congo. gloiremonkoti@gmail.com
Received: January 20, 2026 Revised: February 10, 2026 Accepted: April 14, 2026 Published online: September 9, 2026 Processing time: 194 Days and 18.3 Hours
Abstract
BACKGROUND
Severe malaria remains a major cause of pediatric critical illness and early mortality in sub-Saharan Africa. In pediatric emergency settings, concomitant bacterial sepsis is often under-recognized because of overlapping clinical manifestations, which may delay appropriate antimicrobial therapy and worsen outcomes. Data on severe malaria-bacterial sepsis co-infection among critically ill children in Kinshasa remain limited.
AIM
To determine the frequency of severe malaria-bacterial sepsis co-infection and identify the associated clinical and biological factors among critically ill children.
METHODS
This prospective multicenter observational study was conducted from September 2014 to September 2015 in four pediatric emergency departments in Kinshasa, Democratic Republic of Congo. Children aged 6 months to 15 years admitted with life-threatening conditions and confirmed severe malaria were included. Bacterial sepsis was defined by a positive blood culture for a pathogenic organism. Clinical and laboratory variables were compared using Fisher’s exact test and the Mann-Whitney U test. Multivariable logistic regression was performed to identify factors independently associated with co-infection.
RESULTS
Among 138 children admitted with life-threatening conditions, 96 (69.6%) had confirmed severe malaria. Severe malaria-bacterial sepsis co-infection was identified in 11 children, representing 11.5% of severe malaria cases. In univariate analysis, respiratory distress, splenomegaly, and hypoglycemia were more frequent among co-infected children. In multivariable analysis, respiratory distress remained independently associated with bacterial co-infection. Early mortality in the emergency department was higher among co-infected children than among those without co-infection. Gram-negative bacteria, predominantly Enterobacteriaceae, accounted for most bloodstream isolates.
CONCLUSION
Severe malaria-bacterial sepsis co-infection is relatively frequent among critically ill children in Kinshasa and is associated with poorer early outcomes. Early and systematic assessment for sepsis at admission may help improve the initial management of children in pediatric emergency settings.
Core Tip: Among children admitted with severe malaria, concomitant bacterial sepsis is not uncommon and may be missed at presentation, contributing to early mortality. In pediatric emergency departments in Kinshasa, simple clinical signs-particularly respiratory distress-may help identify children at higher risk of co-infection, supporting early sepsis assessment and prompt integrated management in resource-limited settings.
