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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