Over-dispersion in malaria-schistosoma co-infection: insights from a meta-analytical approach and systematic review.
Célia Koellsch-Amet, Jérôme Boissier, Ronaldo Augusto
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed malaria–schistosomiasis co-infection patterns in endemic settings, primarily in sub-Saharan Africa, and tested whether co-infections exceeded levels expected if the infections were independent. Of 192 studies in the qualitative synthesis, 59 studies involving 73,383 individuals contributed to the meta-analysis. Co-infection was more frequent than expected by chance (overall OR = 1.20, 95% CI 1.02-1.40), although results varied substantially across studies (I 2 = 89%). School-age children and pregnant women were disproportionately affected; no consistent differences by sex or parasite species were found.
Key findings
- Co-infection exceeded the level expected under independence (overall OR = 1.20, 95% CI 1.02-1.40).
- Between-study heterogeneity was substantial (I 2 = 89%).
- Reported co-infection prevalence ranged from 1.1% in Benin to 36.6% in Mali.
- School-age children and pregnant women were disproportionately affected; subgroup analyses found no consistent differences by sex or parasite species.
Why it matters
The findings suggest that malaria and schistosomiasis do not co-occur randomly across the studied populations, and that some groups may bear a greater burden of both infections. Recognising this pattern can inform how co-infection is monitored in endemic settings. However, the analysis does not establish why the infections cluster or whether one infection influences the risk or course of the other.
What to keep in mind
Substantial heterogeneity across studies limits the consistency of the pooled estimate; the underlying biological and immunological mechanisms remain uncertain.