Table 1 Characteristics of the included studies.

From: A meta-analysis on the prevalence and characteristics of severe malaria in patients with Plasmodium spp. and HIV co-infection

No.

Author, year

Study area (years of the survey)

Study design

Age range

Gender

Participants

HIV status

Plasmodium mono–infections

Detection method for Plasmodium sp.

Severe malaria (mono-infections)

HIV mono-infections

Detection method for HIV

Co-infections

1.

Addissie et al. (2007)21

Ethiopia (2003–2004)

Cross-sectional study

15–34

Male (203), Female (104)

337 P. falciparum

Severe 62

Prostration 18

Hyperparasitemia 17

Cerebral manifestations 16

Other 18

Recently diagnosed

323 (P. falciparum)

Microscopy

Severe malaria 52

Cerebral malaria 16, prostration 18, hyperparasitemia, and other complications (estimated 18)

NA

ELISA

14 (P. falciparum)

Severe malaria 3 (P. falciparum)

2.

Amodu-Sanni et al. (2020)22

Nigeria (2016)

Cross-sectional study

3 months to 15 years

Male (143), Female (137)

140 HIV positive, 140 HIV negative

Undertreated

132 (P. falciparum)

Microscopy

Severe malaria 84

40

ELISA, PCR

100 (P. falciparum)

Severe malaria 46 (P. falciparum)

3.

Berg et al. (2014)2

Mozambique (2011–2012)

Cross-sectional study

18–84

Male (142), Female (126)

212 adults with fever and/or suspected malaria, 56 healthy controls

Recently diagnosed

61 (P. falciparum)

Microscopy, RDT, PCR

Severe malaria 24/52

Hypotension (1/52), Respiratory distress (3/52), Hyperpyrexia (6/50), GCS < 11 and/or convulsions (5/61), Bleeding disturbances and/or hemolysis (1/61), Jaundice (3/61)

Severe anemia (3/55), Hypoglycaemia (0/47), Renal failure (3/46), Hyperparasitaemia (16/53)

NA

RDT, PCR

70 (P. falciparum)

Severe malaria 55/66 (P. falciparum)

Hypotension (0/63), Respiratory distress (15/61), Hyperpyrexia (3/54), GCS < 11 and/or convulsions (6/70), Bleeding disturbances and/or hemolysis (9/70), Jaundice and/or se-bilirubin (13/70), Severe anemia (10/67), Hypoglecemia (5/62), Renal failure (15/63), Hyperparasitemia (33/64)

4.

Berg et al. (2008)23

Mozambique (2006)

Cross-sectional study

16–92

Male (167), Female (166)

333 adult patients

Immunosuppressed

8 (P. falciparum)

Microscopy

Severe malaria 4

Jaundice 1, Renal failure 2, fatal 1

NA

RDT

12 (P. falciparum)

Severe malaria 9 (P. falciparum)

Jaundice 2, Renal failure 6, Fatal 1

5.

Berg et al. (2020)24

Mozambique (2011–2012)

Cross-sectional study

 ≥ 18 years

Male (71), Female (60)

131 P. falciparum

Undertreated

61 (P. falciparum)

Microscopy, RDT

Severe malaria 28

Bleeding disturbances and/or haemolysis 1, Fatal 1

NA

PCR

70 (P. falciparum)

Severe malaria 57 (P. falciparum)

Bleeding disturbances and/or hemolysis 9, Fetal 9

6.

Berkley et al. (2009)25

Kenya (1998–2002)

Cross-sectional study

Children aged ≥ 60 days

NA

3,068 severe P. falciparum, 592 healthy control

Recently diagnosed

P. falciparum

Microscopy

Severe malaria 938/1071

119/684

10/592

ELISA

Severe malaria 133/1071 (P. falciparum)

7.

Beyene et al. (2017)26

Ethiopia (2012–2013)

Cross-sectional study

 < 27 years (139), 27.00–31.99 years (141), 32.0–39.74 years (113), ≥ 39.75 (131)

Male (250), Female (284)

528 people living with HIV/AIDS

Recently diagnosed

NA

Microscopy, RDT

NA

436

Severe anemia 12

NA

92 (52 P. falciparum, 37 P. vivax, and 3 mixed infections)

Severe anemia 25 (Plasmodium spp.)

8.

Bronzan et al. (2007)27

Malawi (1996–2005)

Cross-sectional study

 ≥ 6 months old

Male (250), Female (541)

1388 severe malaria

Recently diagnosed

941 severe malaria (P. falciparum)

NA

941 severe malaria

Cerebral malaria 541/627

Cerebral malaria and severe anemia 291/355, severe anemia 109/137

 

RDT

Severe malaria 178 (P. falciparum)

Cerebral malaria 86/627

Cerebral malaria and severe anemia 64/355, severe anemia 28/137

9.

Chalwe et al. (2009)28

Zambia (2004–2005)

Case–control study

15–49 years

15–19, 20–29, 30–39, 40–49

Male (42), Female (45)

29 severe malaria, 29 uncomplicated malaria, 29 asymptomatic community controls

Immunosuppressed

32 (P. falciparum)

Microscopy, RDT

Severe 2

Jaundice 1

NA

RDT, ELISA, Western blot

55 (P. falciparum)

Severe malaria 27 (P. falciparum)

Impaired consciousness 15,

Severe anemia 5, Convulsions 6, Jaundice 3, Hypoglycemia 11, Hyperparasitemia 6

10.

Cohen et al. (2005)15

South Africa (2001–2002)

A prospective cohort study

15–49 years:

Malaria-mono-infection: 29 (17–49)

Co-infection: 30 (17–49)

Malaria-mono-infection: Male (178), Female (48)

Co-infection: Male (85), Female (25)

502 P. falciparum patients

Immunosuppressed

226 (P. falciparum)

Microscopy, RDT

Severe malaria 14: Cerebral malaria 4, Severe anemia 0

Renal impairment 9, Shock 2, Acidosis 3, Hypoglycemia 0, Hepatic dysfunction 8

NA

RDT, ELISA

110 (P. falciparum)

Severe malaria 18 (P. falciparum): Cerebral malaria 3

Severe anemia 3, Renal impairment 14, Shock 2, Acidosis 11, Hypoglycemia 1, Hepatic dysfunction 6

11.

Davenport et al. (2010)29

Kenya (2004–2006)

Cross-sectional study

3–36 months

Malaria-mono-infection: Male (219), Female (187)

Co-infection: Male (14), Female (10)

542 with P. falciparum

Undertreated

406 (P. falciparum)

Microscopy

Severe anemia 44

NA

RDT, PCR

24 (P. falciparum)

Severe anemia 14 (P. falciparum)

12.

Grimwade et al. (2004)42

South Africa (2000)

Cross-sectional study

Adults (> 14 y): Malaria-mono-infection: 28 (18–43)

Co-infection: 30 (22–42)

Malaria-mono-infection: Male (211), Female (222)

Co-infection: Male (70), Female (110)

1,109 febrile adults

Recently diagnosed

433 (P. falciparum)

Microscopy, RDT

Severe malaria 62:

Severe malaria 18:

Impaired renal function 32, Coma 16, Severe anemia 22, Pulmonary edema 2, Bleeding 0, Acidosis 13, Confusion 18, Jaundice 3

152

ELISA

180 (P. falciparum)

Severe malaria 18 (P. falciparum):

Renal failure 28, Coma 16, Severe anemia 14, Pulmonary edema 4, Bleeding 2, Acidosis 15, Confusion 7, Jaundice 9

13.

Hendriksen et al. (2012)30

Mozambique (2005–2010)

Cross-sectional study

Malaria-mono-infection: 2.5–23

Co-infection: 3–38

Age group < 15 and > 15 years

Malaria-mono-infection: Male (6314), Female (286)

Co-infection: Male (68), Female (55)

896 with suspected severe malaria

Recently diagnosed

600 (P. falciparum)

Microscopy, RDT

Severe malaria 549

Coma 454, Convulsions 516, Prostration 137, Shock 21, Severe respiratory distress 38, Severe acidosis 109, Hypoglycemia 33, Severe anemia with respiratory distress 67, Black water fever 28, Severe jaundice 17, Hyperparasitemia 109

NA

RDT, PCR

123 (P. falciparum)

Severe malaria 107 (P. falciparum)

Coma 89, Convulsions 74, Prostration 31, Shock 6, Severe respiratory distress 20, Severe acidosis 38, Hypoglycemia 10, Severe anemia with respiratory distress 18, Black water fever 15, Severe jaundice 9, Hyperparasitemia 33

14.

Hochman et al. (2015)31

Malawi (1996–2010)

Case–control study

6 months to 12 years

Malaria-mono-infection: Male (39), Female (18)

Co-infection: Male (7), Female (8)

103 autopsy tissues

Recently diagnosed

57 (P. falciparum)

ELISA

Cerebral malaria 57

NA

IHC

Cerebral malaria 15 (P. falciparum)

15.

Huson et al. (2015)32

Gabon (2012–2013)

Prospective observational study

age ≥ 18 years

Malaria-mono-infection: Male (44), Female (69)

Co-infection: Male (0), Female (14)

103 patients with sepsis 127 patients with malaria, 60 HIV infected control

Undertreated

133 (P. falciparum)

Microscopy

0

Fetal 0

 

RDT, PCR

14 (P. falciparum)

Fetal 1 (P. falciparum)

16.

Imani et al. (2011)43

Uganda (2006–2007)

Case–control study

 < 12 years

Cerebral malaria: Male (70), Female (30), uncomplicated malaria: Male (92), Female (40), non-malaria: Male (84), Female (36)

352 children:

100 cerebral malaria, 132 uncomplicated malaria, 120 non-malaria

Recently diagnosed

220 (P. falciparum)

Microscopy

220

Cerebral malaria 91/220

NA

RDT

12 (P. falciparum)

Cerebral malaria 9/12 (P. falciparum)

17.

Jacques et al. (2019)33

Congo (2017–2018)

Cross-sectional study

12–60 years

Co-infection 12–60 years

Male (111), Female (114)

225 undernourished children (200 malaria)

Recently diagnosed

NA

Microscopy

NA

NA

RDT, ELISA, PCR

168 (Plasmodium spp.)

Severe anemia 86 (Plasmodium spp.)

18.

Joice et al. (2016)34

Malawi (1996–2011)

Case–control study

Malaria-mono-infection: 3.1–8.8

Co-infection: 1.7–3.6

Malaria-mono-infection: Male (38), Female

Co-infection: Male (9), Female (11)

103 autopsy cases

NA

75 (P. falciparum)

IHC

Cerebral malaria 75

NA

PCR

Cerebral malaria 20/95 (P. falciparum)

19.

Kyeyune et al. (2014)44

Malawi (2002–2004)

Prospective observational study

aged < 2 years

NA

391 children with severe anemia

Recently diagnosed

183/312 (P. falciparum)

Microscopy

severe anemia 183

19

RDT, PCR

26/45 (P. falciparum)

Severe anemia 26 (P. falciparum)

20.

Mandala et al. (2018)35

Malawi (2005–2006)

Cross-sectional study

1.2–4.6 years

Male (5), Female (33)

38 Cerebral malaria, 35 severe malarial anemia, control 42, HIV positive 4

Recently diagnosed

Severe malaria 59 (P. falciparum)

Microscopy

59

Cerebral malaria 29,

Severe anemia 30

4

RDT, PCR

14 (P. falciparum)

Cerebral malaria 9,

Severe anemia 5

21.

Mouala et al. (2008)36

France (1996–2003)

Retrospective study

 < 30, 30–39, 40–49, > 50 years

Male (99), Female (91)

190 imported malaria

P. falciparum 178, other species 12

Undertreated

150 (P. falciparum)

Microscopy

Severe malaria 54

NA

PCR

28 (P. falciparum)

Severe malaria 11 (P. falciparum)

22.

Munyenyembe et al. (2018)37

Malawi (2016–2017)

Cross-sectional study

Malaria-mono-infection: 20–67

Co-infection: 18–66

Male (50), Female (57)

107 participants with malaria

Undertreated

76 (P. falciparum)

Microscopy, RDT

Severe malaria 18

NA

RDT

30 (P. falciparum)

Severe malaria 12 (P. falciparum)

23.

Niyongabo et al. (1994)45

Burundi (1991–1992)

Cross-sectional study

Adults

Male (22), Female (9)

31 cerebral malaria (P. falciparum)

Recently diagnosed

29 (P. falciparum)

Microscopy

Severe malaria 17

NA

ELISA, Western blot

Severe malaria 12 (P. falciparum)

24.

Nkuo-Akenji et al. (2008)38

Cameroon (2006)

Cross-sectional study

15–49 years: 15–25, 26–35 and 36–49 years

Male (183), Female (501)

684 outpatients

Undertreated

324 (P. falciparum)

Microscopy

Hyperparasitemia 84

57

RDT

201 (P. falciparum)

Hyperparasitemia 102 (P. falciparum)

25.

Otieno et al. (2006)46

Kenya

A prospective cohort study

Children < 2 years: Malaria-mono-infection: 11.66 (0.45)

Co-infection: 12.04 (1.34)

Malaria-mono-infection: Male (109), Female (85)

Co-infection: Male (12), Female (12)

317 Children

Recently diagnosed

194 (P. falciparum)

Microscopy

Severe anemia 37

NA

RDT, PCR

23 (P. falciparum)

Severe anemia 15 (P. falciparum)

26.

Sandie et al. (2019)39

Cameroon (2014)

Cross-sectional study

1–72 years

Male (112), Female (299)

HIV positive patients

Recently diagnosed and undertreated

34 (Plasmodium spp.)

Microscopy

Severe anemia 1/3

285

RDT

24 (Plasmodium spp.)

Severe anemia 1/9 (Plasmodium spp.)

27.

Saracino et al. (2012)40

Mozambique (2010)

Cross-sectional study

 > 15 years

Male (262), Female (168)

330 adult patients

Undertreated

39 (P. falciparum)

Microscopy, RDT

Severe malaria 17

NA

RDT

51 (P. falciparum)

Severe malaria 29 (P. falciparum)

28.

Tagoe DNA and Boachie (2012)41

Ghana

Cross-sectional study

18–65 years

Male (59), Female (161)

220 adults with HIV

Undertreated

NA

Microscopy, RDT

NA

186

NA

34 (P. falciparum)

Severe anemia 6 (P. falciparum)

29.

Tay et al. (2015)17

Ghana (2011–2012)

Cross-sectional study

1–73 years: 1–4 (12), 5–9 (2), 10–14 (9), 15–24 (37), 25–34 (147), 35–44 (138), 45–60 (69), > 60 (5)

Male (108), Female (292)

400 HIV sero-positive participants

Undertreated and immunosuppressed

NA

Microscopy

NA

326

RDT

47 (Plasmodium spp.)

Severe anemia 11 (Plasmodium spp.)

  1. ELISA enzyme-linked immunosorbent assay, GCS Glasgow Coma Scale, IHC immunohistochemistry, NA not applicable, P. Plasmodium, PCR polymerase chain reaction, RDT rapid diagnostic testing.