Coinfections and comorbidities in African health systems: At the interface of infectious and noninfectious diseases

Abstract

There is a disease epidemiological transition occurring in Africa, with increasing incidence of noninfectious diseases, superimposed on a health system historically geared more toward the management of communicable diseases. The persistence and sometimes emergence of new pathogens allows for the occurrence of coinfections and comorbidities due to both infectious and noninfectious diseases. There is therefore a need to rethink and restructure African health systems to successfully address this transition. The historical focus of more health resources on infectious diseases requires revision. We hypothesise that the growing burden of noninfectious diseases may be linked directly and indirectly to or further exacerbated by the existence of neglected tropical diseases (NTDs) and other infectious diseases within the population. Herein, we discuss the health burden of coinfections and comorbidities and the challenges to implementing effective and sustainable healthcare in Africa. We also discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for noninfectious disease intervention. Furthermore, we explore the potential for new technologies-including artificial intelligence and multiplex approaches-for diagnosis and management of chronic diseases for improved health provision in Africa.

Fig 1. Adapted maps of Africa showing the overlap of neglected tropical diseases (NTDs), infectious, and noninfectious diseases.

The figure shows (A) pathogeographic patterns of 187 global human infectious diseases [3], (B) patterns of the six most common neglected tropical diseases [4], (C) burden of the most frequently diagnosed cancer among males [10], and (D) probability of dying from the four main noninfectious diseases between the ages of 30 and 70 years [11]. Infectious diseases show distinct spatial patterns (A), which overlap with the most common neglected tropical diseases (B), commonly diagnosed cancers (C), and the mortality rates from major noninfectious diseases including cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes (D).

Fig 2. Host infectome analysis based on IgM reactivity to multiple infections in a Zimbabwean cohort.

Results indicate variable responses to infections across all age groups. IgM, immunoglobulin (Ig) M.

Fig 3. Summary of infections and the types of cancers they cause, via direct or indirect links.

Each coloured line/alphabet represents a pathological pattern. Information adapted from ^aCrosbie, Einstein, and colleagues, 2013 [16]; ^bAhmadi Ghezeldasht, Shirdel, and colleagues, 2013 [55]; ^cMarra, Sordelli, and colleagues, 2011 [56]; ^dMostafa, Sheweita, and colleagues, 1999 [57]; ^eDittmer and Damania, 2016 [58]; ^fPolk and Peek, 2010 [59]; and ^gBower, Nelson, and colleagues, 2005 [17]. HHV8, human herpes virus 8; KSHV, Kaposi sarcoma-associated herpesvirus; HIV, human immunodeficiency virus.