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Table 1 Characteristics of the included studies

From: Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection: a systematic review and meta-analysis

No. Author, year, reference number Study area
(years of the survey)
Study design Age range (mean or median (SD) Sex (n) Participants Plasmodium species in co-infection (n) Severe isolated dengue (n/N)** Severe isolated malaria (n/N) ** Severe malaria from dengue virus–Plasmodium
co-infection (n/N) ** a
Severe dengue from dengue virus–Plasmodium co-infection (n/N) ** b Severe diseases (n/N) **
1. Ahmad et al., 2016, [25] India (2012–2013) Retrospective observational study Co-infection: 38.6 (16)
Malaria: 35.7 (14.5)
Dengue: 36.9 (14.9)
Co-infection: male (8), female (1)
Malaria: male (35), female (26)
Dengue: male (38), female (20)
298 patients with febrile illness P. vivax (9) 11/58
Metabolic acidosis (2), shock (2), seizures (4), death (3)
8/61
Renal failure (2), shock (2), seizures (2), death (2)
1/9
Renal failure (1)
1/9
Renal failure (1),
*hypotension (1)
2/9
2. Ahmad et al., 2019, [30] India (2017) Cross-sectional observational study Co-infection: 7.04 (5.01)
Malaria: 5.67 (4.44)
Dengue: 10.6 (2.82)
Co-infection: male (10), female (3)
Malaria: male (30), female (22)
Dengue: male (47), female (27)
164 children with febrile illness P. falciparum (11), P. vivax (2) 9/74
Altered mental status (1), haematemesis or melaena (8), death (5),
*hypotension (17)
19/52
Altered mental status (8), seizures (4), Jaundice (3), Hypotension (4), death (3)
4/13
Altered mental status (2), seizures (1), hypotension (1), death (1)
5/13
Altered mental status (2), seizures (1), haematemesis or melaena (2), death (1),
*hypotension (1)
6/13
3. Assir et al., 2014, [26] Pakistan (2012) Cross-sectional observational study 22 years (range: 12–90 years) Male (64), female (21) 856 suspected cases of dengue fever P. falciparum (3), P. vivax (14) 2/5
Jaundice (2),
*hypotension (0)
10/18
Impaired consciousness (1), hypotension (1), bleeding (3), renal failure (1), jaundice (4)
7/17
Hypotension (2), bleeding (5)
5/17
WHO grade 2 bleeding (5),
*hypotension (2)
7/17
4. Barua A and Gill N, 2016, [27] India (2014) Cross-sectional observational study (> 12 years) NA 156 acute febrile adult cases NA 2/85
Altered consciousness (1), bleeding (1),
*hypotension (4)
15/55
Altered consciousness (2), hypotension (4), bleeding (2), acute renal failure (2), jaundice (2), death (3)
6/16
Hypotension (1), bleeding (2), acute renal failure (1), jaundice (1), death (1)
5/16
Bleeding (2), acute renal failure (1), jaundice (1), death (1), *hypotension (1)
6/16
5. Carme et al., 2009, [28] French Guiana (2004–2005) Retrospective observational study NA NA 1723 suspected cases of dengue fever or malaria P. falciparum (3), P. vivax (14) NA NA 1/17 (P. vivax)
Severe anaemia (1)
0/17 1/7
6. Epelboin et al., 2012, [11] French Guiana (2004–2010) Retrospective matched-pair study Co-infection:
<  15 (11), >  15 (93)
Mean 33.8 years (range: 6 months to 83 years)
Co-infection (104): male (75), female (29) Patients with malaria and dengue P. falciparum (NA), P. vivax (NA) 51/208
Shock signs (5), neurological disorders (8), jaundice (6), haemorrhagic signs (32),
*hypotension (3)
39/208*
Haemorrhagic signs (25), shock signs (8), neurological disorders (5)
34/104*
Haemorrhagic signs (12), shock signs (7), neurological disorders (7)
35/104
Shock signs (7), neurological disorders (7), jaundice (9), haemorrhagic signs (12), *hypotension (10)
34/104
7. Halsey et al., 2016, [29] Peru (2002–2011) Cross-sectional observational study Co-infection: 29.0 (17.3)
Malaria: 29.6 (16.1)
Dengue: 27.8 (13.1)
Co-infection: male (12), female (5)
Malaria: male (29), female (15)
Dengue: male (36), female (15)
Patients with febrile illness P. falciparum (3), P. vivax (14) 0/51 3/41
Prostration 3/41
2/15
Prostration 2/15
0/51 2/15
8. Kamath et al., 2019, [31] India (2017–2019) Prospective observational study    778 patients with febrile illness NA 232/420
Bleeding (178/420), renal failure (54/420),
*hypotension (70)
NA 15/15
Bleeding (10), renal failure (1), hypotension (4), death from respiratory distress (1)
12/15
Bleeding (10), renal failure (1), death from respiratory distress (1),
*hypotension (4)
15/15
9. Magalhaes et al., 2012, [13] Brazil (2009–2010) Case series Median 38 (16–97) Co-infection: male (0), female (11) 132 patients with severe P. vivax malaria P. vivax (11) NA/132 NA 8/11*
Jaundice (8), severe anaemia (1), hypotension (1), pulmonary oedema (1)
10/11*
Mucosal bleeding (6), *hypotension (1)
10/11
10. Magalhaes et al., 2014, [14] Brazil (2009–2011) Cross-sectional observational study NA NA 1578 patients with febrile illness P. vivax (44) 211/584*
Jaundice (3), deep bleeding (76)
45/176* 7/44* 32/44*
Jaundice (29), deep bleeding (15)
39/44
11. Mohapatra et al., 2012, [15] India (2011) Prospective observational
study
NA Co-infection: male (8), female (29)
Malaria: male (68), female (34)
Dengue: male (220), female (120)
546 suspected cases of dengue and malaria P. falciparum (24), P. vivax (2), mixed infection (1) 140/340
Bleeding 140
90/102*
Death (11)
1/27* 10/27
Bleeding 10
11/27
12. Sonkar et al., 2019, [32] India (2018) Cross-sectional observational study   NA 994 patients with febrile illness P. falciparum (16), P. vivax (13), mixed infection (1) NA/279 NA/685 17/30
Jaundice (12),
bleeding (5)
NA 17/30
13. Verma et al., 2016, [33] India (2015) Prospective observational study Adult (>  18 yrs) Male (256), female (84) 340 patients with febrile illness NA 38/156
CNS involvement (2), bleeding (32), respiratory distress (4)
*hypotension (28)
63/132
CNS involvement (12), bleeding (4), hypotension (4), respiratory distress (20), severe anaemia (20), death (3)
27/52
Bleeding (8), hypotension (3), respiratory distress (4), severe anaemia (12)
12/52
Bleeding (8), respiratory distress (4),
*hypotension (3)
26/52
           impaired consciousness (9), multiple convulsions (1), prostration (2), shock/hypotension (19), hypoglycaemia (0), jaundice (21), pulmonary oedema (1), bleeding (42), metabolic acidosis or acute respiratory distress (4), severe anaemia (14), and acute renal failure (3) Shock (7), respiratory distress (4), severe bleeding (58), renal failure (3), impaired consciousness (9), multiple convulsions (1), jaundice (39)  
  1. * Severe cases defined by authors
  2. ** n/N: Out of N confirmed cases, there are a total of n severe cases; NA: not applicable
  3. a WHO malaria- Severity Criteria for Malaria from World Health Organization, 2014
  4. b WHO dengue- Severity Criteria for Dengue from World Health Organization, 2009