Abstract
BackgroundThe awareness of non-malarial febrile illnesses (NMFIs) has been on the rise over the last decades. Therefore, we undertook a systematic literature review and meta-analysis of causative agents of non-malarial fevers on the African continent.MethodologyWe searched for literature in African Journals Online, EMBASE, PubMed, Scopus, and Web of Science databases to identify aetiologic agents that had been reported and to determine summary estimates of the proportional morbidity rates (PMr) associated with these pathogens among fever patients.FindingsA total of 133 studies comprising 391,835 patients from 25 of the 54 African countries were eligible. A wide array of aetiologic agents were described with considerable regional differences among the leading agents. Overall, bacterial pathogens tested from blood samples accounted for the largest proportion. The summary estimates from the meta-analysis were low for most of the agents. This may have resulted from a true low prevalence of the agents, the failure to test for many agents or the low sensitivity of the diagnostic methods applied. Our meta-regression analysis of study and population variables showed that diagnostic methods determined the PMr estimates of typhoidal Salmonella and Dengue virus. An increase in the PMr of Klebsiella spp. infections was observed over time. Furthermore, the status of patients as either inpatient or outpatient predicted the PMr of Haemophilus spp. infections.ConclusionThe small number of epidemiological studies and the variety of NMFI agents on the African continent emphasizes the need for harmonized studies with larger sample sizes. In particular, diagnostic procedures for NMFIs should be standardized to facilitate comparability of study results and to improve future meta-analyses. Reliable NMFI burden estimates will inform regional public health strategies.
Highlights
There has been tremendous progress in the control of fevers that are attributable to Plasmodium falciparum in Africa [1]
The small number of epidemiological studies and the variety of non-malarial febrile illnesses (NMFIs) agents on the African continent emphasizes the need for harmonized studies with larger sample sizes
A total of 5730 studies were identified by our database searches and 133 articles representing 391,835 febrile patients were included in the systematic review
Summary
There has been tremendous progress in the control of fevers that are attributable to Plasmodium falciparum in Africa [1]. Five countries on the continent have been certified as malaria-free [2]. This success is largely due to intensive control strategies such as the use of insecticide-treated bed nets, indoor residual spraying, and the use of artemisinin-based combination therapy for the treatment of clinical malaria cases [3]. As the malaria incidence reported in some African countries has recently increased [7], defining the burden of NMFIs will lessen complications in malaria control programs as well as raise awareness of their existence in communities [8,9]. We undertook a systematic literature review and meta-analysis of causative agents of non-malarial fevers on the African continent
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