{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:37:46Z","timestamp":1792507066650,"version":"4.5.0"},"reference-count":60,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012190","name":"Polish Ministry of Science and Higher Education (MNiSW) through institutional subsidy funding","doi-asserted-by":"publisher","award":["667\/WIM\/2024"],"award-info":[{"award-number":["667\/WIM\/2024"]}],"id":[{"id":"10.13039\/501100012190","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Military Institute of Medicine\u2013National Research Institute, Warsaw, Poland"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Malaria remains a major cause of hospitalization in rural Madagascar, yet data on in-hospital clinical presentation, management, and patient outcomes remain limited. Methods: We conducted a three-year retrospective study (2023\u20132025) at a rural district hospital in Ambatoboeny, Madagascar, including patients of all ages hospitalized with malaria confirmed by rapid diagnostic testing and microscopy. Sociodemographic, clinical, laboratory, and treatment data were extracted from routine records. Length of hospital stay (LOS) was analyzed continuously and categorized as \u22642, 3\u20134, or \u22655 days. Seasonal admission patterns and factors associated with LOS were assessed using chi-square or Fisher\u2019s exact tests, and associations with rainfall seasonality were explored using Spearman\u2019s correlation. Results: Among 134 hospitalized patients, median age was 15 years (interquartile range (IQR) 7\u201325) and 52.2% were female. Plasmodium falciparum predominated (94.0%), while mixed-species infections were identified in 6.0% of cases; 20.1% of cases were classified as severe malaria, including 10.4% with cerebral malaria. Co-infections were frequent (52.2%), most commonly Schistosoma haematobium infection (14.2%) and typhoid fever (12.7%). Intravenous artesunate was initiated in 97.8% of patients; all received paracetamol and 94.8% received intravenous fluids. Median LOS was 2 days (IQR 2\u20133); 12.7% had prolonged hospitalization (\u22655 days). Prolonged LOS was significantly associated with cerebral malaria, high parasitemia (\u22655%), blood transfusion, and age &lt; 15 years (all p \u2264 0.034), while co-infection and nutritional status were not. Conclusions: Hospitalized malaria in rural Madagascar presents with heterogeneous clinical phenotypes and a high burden of co-infections. Prolonged LOS is primarily driven by markers of severe disease and supportive care requirements, underscoring the need for early severity recognition and resource planning in low-resource hospitals.<\/jats:p>","DOI":"10.3390\/jcm15062389","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:02:43Z","timestamp":1774026163000},"page":"2389","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Characteristics and Outcomes of Hospitalized Malaria Patients in Rural Madagascar"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6357-2418","authenticated-orcid":false,"given":"Daniel","family":"Kasprowicz","sequence":"first","affiliation":[{"name":"Clinique M\u00e9dicale Beyzym, Manerinerina RN6, Ambatoboeny District, Manerinerina 403, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0505-6279","authenticated-orcid":false,"given":"Krzysztof","family":"Korzeniewski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Tropical Medicine, Military Institute of Medicine\u2013National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1932-9784","authenticated-orcid":false,"given":"Wanesa","family":"Wilczy\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Tropical Medicine, Military Institute of Medicine\u2013National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, January 30). 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