Falciparum Malaria in Febrile Patients at Sentinel Sites for Influenza Surveillance in the Central African Republic from 2015 to 2018

Abstract

Malaria is a major public health issue in the Central African Republic (CAR) despite massive scale-up of malaria interventions. However, no information is available on the incidence of malaria in febrile illness cases or on the distribution of malaria infection according to demographic characteristics, which are important indicators and valuable epidemiological surveillance tools. This study therefore aimed to characterize malaria in the network of sentinel sites set up for influenza surveillance. A retrospective analysis was conducted to explore the data from these sentinel sites from 2015 to 2018. The Paracheck-Pf® rapid diagnosis test kit was used to screen for malaria in febrile illness cases. A total of 3609 malaria cases were identified in 5397 febrile patients, giving an incidence rate of 66.8%. The age group of 1–4 years was the most affected by malaria (76.0%). Moreover, prevalence varied across different sentinel sites, with the Bossembele Health Center, located in a rural area, showing an incidence of 96%, the Saint Joseph Health Center in a semiurban area of Bangui showing an incidence of 75%, and the Bangui Pediatric Complex in an urban site with an incidence of only 44.6%. Malaria transmission was holoendemic over the four-year study period, and malaria incidence decreased from 2016 to 2018. The incidence of malaria coinfection with influenza was 6.8%. This study demonstrated clear microspatial heterogeneity of malaria. Malaria was consistently the most frequent cause of febrile illness. Including sites in different climate zones in the CAR will allow for a more representative study.

Prevalence and Characteristics of Malaria and Influenza Co-Infection in Febrile Patients: A Systematic Review and Meta-Analysis

“…Additional searches from reference lists of the included studies and Google Scholar found no other relevant studies. Therefore, ultimately, 10 studies [11,13,14,[20][21][22][23][24][25][26] were included for qualitative and quantitative syntheses (Figure 1). full text unavailable, (vi) 2 knowledge assessments, (vii) 2 with non-English language, (viii) 1 systematic review, and (ix) 1 co-infection study from which data could not be extracted.…”

“…Additional searches from reference lists of the included studies and Google Scholar found no other relevant studies. Therefore, ultimately, 10 studies [11,13,14,[20][21][22][23][24][25][26] were included for qualitative and quantitative syntheses (Figure 1).…”

“…In humans, severe disease and seasonal epidemics are mostly caused by influenza viruses A and B [11,12]. Previous studies reported the high incidence of influenza in Africa in Nigeria, Tanzania, Kenya, the Central African Republic, and Malawi [11,13,14]. At least 3 million severe influenza cases have been reported, with 290,000 to 650,000 deaths annually [15].…”

“…The clinical symptoms of influenza range from mild respiratory tract infection to acute/chronic disease and are similar to those of other acute febrile illnesses (AFIs), such as pneumonia, typhoid fever, and malaria [11,14]. These overlapping symptoms include fever, chills, headache, and joint and muscle pain [13,16,17]. Children younger than 5 years old are the most vulnerable to morbidity and mortality caused by infection from malaria and influenza [14].…”

Malaria research in the Central African Republic from 1987 to 2020: an overview

“…Restricting studies to Bangui can be attributed to the lack of qualified infrastructures in the outlying provinces and especially to conflicts, unrest, and the military crisis, which have a greater impact in the provinces. Notwithstanding, a study carried out in the network of sentinel sites set up for epidemiological surveillance in the CAR revealed spatial variability in malaria prevalence, with high prevalence in rural and semi-urban areas [ 14 ]. Nevertheless, this bibliographic survey provides a sound scientific basis for guiding future control measures against malaria in the CAR and allowed domestic experts to identify the needs for research on malaria in this geographically and digitally landlocked country, with no direct access to broadband internet and connectivity issues.…”