Epidemiology of malaria among HIV/AIDS patients in sub-Saharan Africa: A systematic review and meta-analysis of observational studies

Obebe, Oluwasola Olaiya; Falohun, Olufarati Oludunsin

doi:10.1016/j.actatropica.2020.105798

Cited by 8 publications

(5 citation statements)

References 58 publications

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“…The population subgroups considered to be at higher risk of contracting malaria include children under 5 years of age [ 15 , 16 ], pregnant women [ 17 ], and patients with HIV/AIDS [ 18 ]. Refugees are rendered vulnerable to malaria infections by their lack of protective immunity, increased concentration of people in exposed settings, limited distribution of ITNs, inadequate IRS, insufficient rapid clinical diagnostic and treatment responses [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants of malaria infections among children in refugee settlements in Uganda during 2018–2019

et al. 2023

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Background While 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda. Methods We utilized data from Uganda’s Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors. Results Overall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (aOR) = 1.22, 95% CI: 0.08–0.59, P = 0.002], boreholes (aOR = 2.11, 95% CI: 0.91–4.89, P = 0.018) and water tanks (aOR = 4.47, 95% CI: 1.67–11.9, P = 0.002). Other factors included pit-latrines (aOR = 1.48, 95% CI: 1.03–2.13, P = 0.033), open defecation (aOR = 3.29, 95% CI: 1.54–7.05, P = 0.002), lack of insecticide treated bed nets (aOR = 1.15, 95% CI: 0.43–3.13, P = 0.003) and knowledge on the causes of malaria (aOR = 1.09, 95% CI: 0.79–1.51, P = 0.005). Conclusions The persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness. Graphical Abstract

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Section: Introductionmentioning

confidence: 99%

Determinants of malaria infections among children in refugee settlements in Uganda during 2018–2019

et al. 2023

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“…PLHIV could contribute to 1.2% of all estimated uncomplicated malaria cases and between 2.6% and 6.6% of estimated excess failures. As antiretroviral therapy (ART) coverage increases [56] together with a shift towards dolutegravir-based ARTs that have fewer drug-drug interactions [57], PLHIV may become less at risk of sub-optimal ACT dosing with standard 3-day regimen; this risk remains however for those receiving rifampicin-based tuberculosis treatment or efavirenz-based ARTs [58,59]. Furthermore, PLHIV have higher parasites densities and children infected with HIV have been reported having slower parasite clearance than HIV-free children [60].…”

Section: Discussionmentioning

confidence: 99%

Characterisation of populations at risk of sub-optimal dosing of artemisinin-based combination therapy in Africa

Takyi,

Carrara,

Dahal

et al. 2023

PLOS Glob Public Health

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Selection of resistant malaria strains occurs when parasites are exposed to inadequate antimalarial drug concentrations. The proportion of uncomplicated falciparum malaria patients at risk of being sub-optimally dosed with the current World Health Organization (WHO) recommended artemisinin-based combination therapies (ACTs) is unknown. This study aims to estimate this proportion and the excess number of treatment failures (recrudescences) associated with sub-optimal dosing in Sub-Saharan Africa. Sub-populations at risk of sub-optimal dosing include wasted children <5 years of age, patients with hyperparasitaemia, pregnant women, people living with HIV, and overweight adults. Country-level data on population structure were extracted from openly accessible data sources. Pooled adjusted Hazard Ratios for PCR-confirmed recrudescence were estimated for each risk group from published meta-analyses using fixed-effect meta-analysis. In 2020, of the estimated 153.1 million uncomplicated P. falciparum malaria patients in Africa, the largest risk groups were the hyperparasitaemic patients (13.2 million, 8.6% of uncomplicated malaria cases) and overweight adults (10.3 million, 6.7% of uncomplicated cases). The estimated excess total number of treatment failures ranged from 0.338 million for a 98% baseline ACT efficacy to 1.352 million for a 92% baseline ACT efficacy. Our study shows that an estimated nearly 1 in 4 people with uncomplicated confirmed P. falciparum malaria in Africa are at risk of receiving a sub-optimal antimalarial drug dosing. This increases the risk of antimalarial drug resistance and poses a serious threat to malaria control and elimination efforts. Changes in antimalarial dosing or treatment duration of current antimalarials may be needed and new antimalarials development should ensure sufficient drug concentration levels in these sub-populations that carry a high malaria burden.

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“…In addition, malaria and severe pneumonia co-infections might increase the odds of HIV infection as some included studies enrolled patients with HIV 15 , 16 , 26 , 27 . The impact of HIV on clinical malaria had been exclusively described in the previous systematic review 35 – 37 . The co-infection of malaria and HIV could lead the patients to severe malaria 35 and might impact the clinical presentation of severe pneumonia 11 .…”

Section: Discussionmentioning

confidence: 99%

Evidence of and deaths from malaria and severe pneumonia co-infections in malaria-endemic areas: a systematic review and meta-analysis

Mala

Wilairatana

Milanez

et al. 2022

Sci Rep

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Malaria and pneumonia are the leading causes of childhood mortality in children under 5 years of age. Nevertheless, the proportions and deaths of malaria co-infection among patients with severe pneumonia, particularly in children under 5 years of age, and characteristics of co-infection remain poorly explored. Hence, the present study aimed to collate the evidence of malaria among patients with severe pneumonia, severe pneumonia among patients with malaria, and the proportion of deaths among patients with co-infections. Potentially relevant studies were searched in six databases including PubMed, Scopus, Web of Science, Embase, Ovid, and MEDLINE to identify studies on malaria and severe pneumonia co-infections that were published until 21 July 2022 with a restriction for the non-English language but no restriction for the publication year. The quality of the included studies was determined using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The pooled estimates, including the pooled proportion of malaria among patients with severe pneumonia, and the proportion of deaths among patients with co-infections, were estimated by the random-effects model. Of the 4094 studies examined, 11 studies that met the eligibility criteria were included in the review. Meta-analysis results showed that the proportion of malaria (2162 cases) among patients with severe pneumonia (9738 cases) was 19% (95% CI 12–26%, I2: 98.79%, 11 studies). The proportion of severe pneumonia (546 cases) among patients with malaria (10,325 cases) was 20% (95% CI 0–40%, I2: 99.48%, 4 studies). The proportion of deaths among patients with co-infection was 13% (95% CI 2–23%, I2: 85.1%, 3 studies). In conclusion, nearly one-fifth of patients with severe pneumonia have malaria, one-fifth of patients with malaria have severe pneumonia, and about 13% of co-infections lead to deaths. This information raised the clinical importance of diagnosis and management of concurrent infections. Patients with severe pneumonia should be investigated for malaria, and vice versa. Detection of co-infections might provide the information to inform the physician to manage and cure co-infected patients who live in areas where both diseases were endemic.

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Epidemiology of malaria among HIV/AIDS patients in sub-Saharan Africa: A systematic review and meta-analysis of observational studies

Cited by 8 publications

References 58 publications

Determinants of malaria infections among children in refugee settlements in Uganda during 2018–2019

Determinants of malaria infections among children in refugee settlements in Uganda during 2018–2019

Characterisation of populations at risk of sub-optimal dosing of artemisinin-based combination therapy in Africa

Evidence of and deaths from malaria and severe pneumonia co-infections in malaria-endemic areas: a systematic review and meta-analysis

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