Prevalence of Malaria and Typhoid Co-Infection among Patients in Afikpo, Ebonyi State, Nigeria

Abstract

Malaria and typhoid fever are important causes of febrile illness in tropical regions and may occur concurrently in areas where both infections are endemic. Their overlapping clinical manifestations can complicate differential diagnosis and may contribute to inappropriate treatment when laboratory confirmation is inadequate. In Afikpo, environmental conditions and limited awareness of disease aetiology and preventive measures further underscore the need to assess the occurrence of malaria–typhoid co-infection among febrile patients attending local health facilities. The present study examined the occurrence of Salmonella typhi and Plasmodium falciparum co-infection among 200 individuals from Mater Misericordia Hospital Afikpo (MMHA; n=100) and General Hospital Itim Afikpo (GHIA; n=100). Slide agglutination and blood cultures were used to test for typhoid fever, while RDT was performed together with thin- and thick-film microscopy to diagnose malaria. Questionnaires were used to determine the sociodemographic profiles of the patients and their knowledge regarding the causes of the diseases. Awareness was quite low; 12.5% knew that malaria was caused by P. falciparum, while 47.0% correctly identified mosquitoes as vectors and 22.9% knew the importance of insecticide-treated bed nets in prevention. Similarly, 5.5% correctly stated that S. typhi causes typhoid, while 11.1% mistakenly stated that P. falciparum was responsible. Preventive knowledge of typhoid included avoiding raw vegetables (29.7%), handwashing (25.7%), and avoiding contaminated water (21.6%). Microscopic tests revealed 65 (32.5%) cases of malaria, whereas RDTs showed 53 (26.5%) cases. Typhoid-positive cases were detected using the Widal slide test in 43 (21.5%) participants and blood cultures in 24 (12.0%). The largest proportion of microscopy-positive malaria cases occurred in the 36-45-year age group at both health facilities (MMHA 35.3%, GHIA 32.3%); males accounted for 55.9% of microscopy-positive cases at MMHA, whereas females accounted for 58.1% at GHIA. Widal positivity was 20.0% at MMHA and 23.0% at GHIA, while the 36-45-year age group accounted for the largest proportion of blood-culture-positive typhoid cases (MMHA 54.5%, GHIA 38.5%), with no blood-culture-positive cases in participants aged ≥46 years. Among co-infected participants, males accounted for 52.4% at MMHA and 57.1% at GHIA. These findings indicate poor understanding within the community regarding the causative agents of the diseases and further emphasise the importance of public education.