Concurrent malaria and dengue fever in (sub-Saharan) Africa: a systematic review and meta-analysis

Abstract

Introduction Malaria and dengue fever are leading causes of acute undifferentiated febrile illness. In Africa, misdiagnoses of dengue fever as malaria is a common scenario. This systematic review was aimed to determine the prevalence of concurrent malaria and dengue fever, aetiologies, and the association between the two infections in Africa. Methods We assessed evidence from previous studies in Africa that were available in MEDLINE and EMBASE databases between January 01, 2005, and March 30, 2022. Results A total of 3942 studies were identified from the databases of which 30 studies from 13 African countries, including 25,241 febrile patients, were included in the meta-analysis. The result of the meta‐analysis showed a 4.0% pooled prevalence of concurrent malaria and dengue fever in (sub-Saharan) Africa, and the highest rate was recorded in Central Africa (5.8%) followed by East Africa (4.7%) and West Africa (2.8%). Children <18 years old (57%) and females (52.8%) were more affected by the co-infection than adults and females, respectively. The dengue virus serotypes identified were DENV-2, DENV-3, DENV-1, and DENV-4 in descending order with a proportion of 39%, 31%, 27%, and 3%, respectively. Moreover, Plasmodium falciparum was the only specified malaria parasite in the co-infection among the included studies. Significantly higher odds of malaria infection were documented due to dengue fever when compared with malaria mono-infection. However, no significant odds of acute dengue co-infection were recorded due to malaria in contrast to dengue mono-infection. Conclusion This study showed a high prevalence of concurrent malaria and dengue fever in Africa. Healthcare workers should bear in mind the possibility of dengue infection as differential diagnoses for acute febrile illness as well as the possibility of co-existent malaria and dengue in endemic areas. Also, high-quality multi-centre studies are required to verify the above conclusions. Protocol registration number: CRD42022311301. Keywords Prevalence, Co-infection, Malaria, Dengue fever, Dengue virus, DENV, Plasmodium falciparum.