Abstract
BACKGROUND: Anxiety is a common psychological response among caregivers of children with severe illnesses, yet limited research has explored its prevalence and associated factors in guardians of children with severe malaria in Malawi. Understanding the severity of anxiety and its correlates is crucial for supporting caregiver mental health and improving paediatric outcomes. AIM: This study aimed to determine the prevalence and severity of anxiety, and identify social, demographic and clinical factors associated with anxiety among guardians of children admitted with severe malaria. SETTING: The study setting was the Peadiatric ward of Thyolo District Hospital in Malawi. METHODS: A cross-sectional study was conducted involving 187 guardians of children diagnosed with severe malaria. Data were collected using a structured questionnaire incorporating socio-demographic and clinical information, alongside the Generalised Anxiety Disorder 7-item (GAD-7) scale. Descriptive statistics, Chi-square tests and logistic regression were used to analyse the data. RESULTS: Mild anxiety was the most common (79.7%) among participants, followed by moderate (10.7%) and minimal (9.6%), with no cases of severe anxiety. Significant socio-demographic factors associated with higher anxiety included age (p < 0.001), guardian type (p < 0.001), education level (p < 0.001), area of residence (p < 0.001) and source of income (p < 0.001). Clinically, longer hospital stays (p < 0.001) and repeated admissions (p < 0.001) were significantly associated with increased anxiety severity. CONCLUSION: Anxiety is prevalent among guardians of children with severe malaria, with several socio-demographic and clinical factors contributing to its severity. The findings highlight the importance of integrating psychological support services into paediatric care settings. CONTRIBUTION: This study underscores the need for routine anxiety screening, mental health support and context-specific interventions targeting caregivers of hospitalised children with severe illnesses in low-resource settings.