article · Infectious Diseases of Poverty
In sub-Saharan Africa, viral haemorrhagic fevers and malaria share similar clinical presentations, complicating accurate differential diagnosis in healthcare settings. A cross-sectional study conducted across eight districts in Tanzania examined 308 febrile patients visiting primary healthcare facilities to determine the prevalence of these concurrent infections. Blood testing showed that 17.5 percent of participants had malaria, while 4.8 percent tested positive for antibodies indicating exposure to viral haemorrhagic fevers, including Rift Valley fever, Ebola virus disease, Crimean-Congo haemorrhagic fever, Marburg virus disease, and yellow fever. Overall, 1.9 percent of the patients were co-infected with both malaria and a viral haemorrhagic fever. Co-infections were significantly linked to location, with the highest rates found in Buhigwe and Kinondoni districts, and were most frequent in adults aged 46 to 60 years. Common symptoms included severe headache and widespread musculoskeletal pain.
Malaria and viral haemorrhagic fevers can present with virtually identical symptoms, such as fever, headaches, and joint pain. When clinicians rely purely on clinical signs or basic rapid tests, viral haemorrhagic fevers may be overlooked in malaria-endemic areas. Confirming the presence of co-infections underlines the critical need to strengthen laboratory diagnostic capacity in primary healthcare facilities to ensure prompt, correct treatment and early outbreak containment.
The findings highlight an applied clinical need for multi-pathogen point-of-care diagnostic tools capable of simultaneously detecting malaria and viral haemorrhagic fever markers. Diagnostic manufacturers and public health agencies could use these surveillance findings to guide the development and deployment of multiplex testing kits in endemic regions. The research represents early-stage epidemiological evidence, so any direct commercial translation into tailored diagnostic devices remains in development and far from immediate market deployment.
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BACKGROUND: In recent years there have been reports of viral haemorrhagic fever (VHF) epidemics in sub-Saharan Africa where malaria is endemic. VHF and malaria have overlapping clinical presentations making differential diagnosis a challenge. The objective of this study was to determine the prevalence of selected zoonotic VHFs and malaria co-infections among febrile patients seeking health care in Tanzania. METHODS: This facility-based cross-sectional study was carried out between June and November 2018 in Buhigwe, Kalambo, Kyela, Kilindi, Kinondoni, Kondoa, Mvomero, and Ukerewe districts in Tanzania. The study involved febrile patients seeking health care from primary healthcare facilities. Blood samples were collected and tested for infections due to malaria, Crimean-Congo haemorrhagic fever (CCHF), Ebola virus disease (EVD), Marburg virus disease (MVD), Rift Valley fever (RVF) and yellow fever (YF). Malaria infections were tested using rapid diagnostics tests while exposure to VHFs was determined by screening for immunoglobulin M antibodies using commercial enzyme-linked immunosorbent assays. The Chi-square test was used to compare the proportions. RESULTS: A total of 308 participants (mean age = 35 ± 19 years) were involved in the study. Of these, 54 (17.5%) had malaria infection and 15 (4.8%) were positive for IgM antibodies against VHFs (RVF = 8; CCHF = 2; EBV = 3; MBV = 1; YF = 1). Six (1.9%) individuals had both VHF (RVF = 2; CCHF = 1; EVD = 2; MVD = 1) and malaria infections. The highest co-infection prevalence (0.6%) was observed among individuals aged 46‒60 years (P < 0.05). District was significantly associated with co-infection (P < 0.05) with the highest prevalence recorded in Buhigwe (1.2%) followed by Kinondoni (0.9%) districts. Headache (100%) and muscle, bone, back and joint pains (83.3%) were the most significant complaints among those infected with both VHFs and malaria (P = 0.001). CONCLUSIONS: Co-infections of VHF and malaria are prevalent in Tanzania and affect more the older than the younger population. Since the overlapping symptoms in co-infected individuals may challenge accurate diagnosis, adequate laboratory diagnosis should be emphasized in the management of febrile illnesses.
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DOI: 10.1186/s40249-022-00959-z
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