BEYOND FEVER: SPECTRUM OF NEUROLOGICAL COMPLICATIONS IN MALARIA PATIENTS IN DISTRICT KOHAT

Abstract

Background: Malaria remains a major parasitic disease in tropical and subtropical regions, particularly in low- and middle-income countries. Although fever and constitutional symptoms are typical, neurological complications represent a serious and often underrecognized dimension of malaria, especially in endemic areas such as Pakistan. Objective: To evaluate the frequency and spectrum of neurological complications among malaria patients attending hospitals and private clinics in District Kohat. Methods: This hospital- and clinic-based cross-sectional survey included 320 laboratory-confirmed malaria patients. Data was collected using a structured questionnaire covering demographic variables, malaria species (Plasmodium falciparum and Plasmodium vivax), and neurological manifestations. Statistical analysis was performed using SPSS version 26, and associations were assessed using chi-square and logistic regression analysis with a significance level of p < 0.05. Results: Out of 320 patients, P. falciparum accounted for 52.5% and P. vivax for 44.4% of cases. Neurological complications were observed in a considerable proportion of patients, with seizures (13.1%), altered mental status (11.9%), and cerebral malaria (6.9%) being the most frequent manifestations. P. falciparum infection showed a significantly higher association with overall neurological complications (44.0%) compared to P. vivax (32.4%) (p = 0.03). Cerebral malaria was predominantly associated with P. falciparum infection (p < 0.001). Logistic regression identified P. falciparum infection (OR = 2.10, p = 0.005) and delayed treatment (OR = 2.35, p < 0.001) as significant predictors of neurological involvement. Conclusion: Neurological complications constitute a clinically important component of malaria in District Kohat, with P. falciparum being the strongest predictor of severe neurological disease. Early diagnosis and timely treatment are essential to reduce neurological morbidity and improve patient outcomes in endemic settings.