Abstract
Despite efforts to address the burden of fungal infections in Malawi, the prevalence and incidence remain largely unknown. We assessed the annual burden in the general population and among populations at high risk and fungal infection frequencies in each particular population to estimate the national incidence or prevalence. The Malawi population is approximately 17.7 million (2017), with 48% under 15 years of age. Approximately 8% of the population is HIV positive. The most common infections are present in HIV/AIDS patients, with oral candidiasis being the commonest. Life threatening infections among those with AIDS patients include cryptococcal meningitis (8200 cases) and Pneumocystis pneumonia (3690 cases). Pulmonary TB is common, but extra pulmonary TB is rare; an estimated 2329 people have chronic pulmonary aspergillosis after TB. Asthma is a significant problem in Malawi, with an estimated 680,000 adults affected (4.67%) and 14,010 cases of allergic bronchopulmonary aspergillosis (ABPA). Tinea capitis is estimated to be present in over 670,000 young people (21% of school age children). The annual incidence of fungal keratitis is difficult to estimate, but as cases are frequently seen in the eye department, is likely to be a minimum of 1825 (10.3/100,000) cases. Among the most serious infections, cryptococcal meningitis and Pneumocystis pneumonia are top of the list. Overall, some 1,338,523 (7.54%) people are affected by a serious fungal infection in Malawi. These basic estimates are limited, due to poor record keeping, and require epidemiological studies to validate or modify the substantial burden estimates. National surveillance of fungal infections is urgently needed.
Highlights
It is estimated that globally, approximately 300 million people suffer from serious fungal infections annually, and that among these, 1.65 million die [1]
We present a review of the epidemiology of fungal disease in Malawi, with estimates based on available data as of 2017
There are an estimated 979,896 people living with HIV (PLHIV) in Malawi, about 104,093 of whom are children younger than 15 years
Summary
It is estimated that globally, approximately 300 million people suffer from serious fungal infections annually, and that among these, 1.65 million die [1]. As in many poorly resourced African countries, Malawi has no comprehensive data on the burden of fungal infections. The HIV epidemic in Malawi has highlighted Cryptococcus and Candida infections as important opportunistic fungal infections, and has some data for this, but national data for other fungal infections is not readily available. This is partly because a large number of healthy persons with mild superficial or even severe infections may not present at a health facility, such that the sparse data on life-threatening invasive diseases in vulnerable immunocompromised patients usually underestimates the burden of the disease by a large degree.
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