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Review
. 2022 Jan 22;22(1):78.
doi: 10.1186/s12879-022-07064-4.

Low incidence of COVID-19 case severity and mortality in Africa; Could malaria co-infection provide the missing link?

Silas Acheampong Osei  1 , Robert Peter Biney  1 , Alberta Serwah Anning  2 , Lydia Nkuah Nortey  2 , George Ghartey-Kwansah  3
Affiliations
Review

Low incidence of COVID-19 case severity and mortality in Africa; Could malaria co-infection provide the missing link?

Silas Acheampong Osei et al. BMC Infect Dis. .

Abstract

Background: Despite reports of malaria and coronavirus diseases 2019 (COVID-19) co-infection, malaria-endemic regions have so far recorded fewer cases of COVID-19 and deaths from COVID-19, indicating a probable protection from the poor outcome of COVID-19 by malaria. On the contrary, other evidence suggests that malaria might contribute to the death caused by COVID-19. Hence, this paper reviewed existing evidence hypothesizing poor outcome or protection of COVID-19 patients when co-infected with malaria.

Methods: PRISMA guidelines for systematic review were employed in this study. Published articles from December 2019 to May 2021on COVID-19 and malaria co-infection and outcome were systematically searched in relevant and accessible databases following a pre-defined strategy. Studies involving human, in vivo animal studies, and in vitro studies were included.

Results: Twenty three (23) studies were included in the review out of the 3866 records identified in the selected scientific databases. Nine (9) papers reported on co-infection of COVID-19 and malaria. Five (5) papers provided information about synergism of malaria and COVID-19 poor prognosis, 2 papers reported on syndemic of COVID-19 and malaria intervention, and 7 studies indicated that malaria protects individuals from COVID-19.

Conclusions: Low incidence of COVID-19 in malaria-endemic regions supports the hypothesis that COVID-19 poor prognosis is prevented by malaria. Although further studies are required to ascertain this hypothesis, cross-immunity and common immunodominant isotopes provide strong evidence to support this hypothesis. Also, increase in co-inhibitory receptors and atypical memory B cells indicate synergy between COVID-19 and malaria outcome, though, more studies are required to make a definite conclusion.

Keywords: COVID-19; Malaria; Malaria-COVID 19 co-infection; Plasmodium falciparum; SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests in the work described here or the interpretation thereof.

Figures

Fig. 1
Fig. 1
The flowchart of study identification and study selection process
Fig. 2
Fig. 2
A pie chart showing the characteristics of included studies. 8 papers were conducted in Europe, 7 were obtained from Asia, 7 were extracted from studies conducted in Africa, and 1 study involved collaboration from different continents (global)
See this image and copyright information in PMC

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