The Role of COVID-19 Pandemic on Malaria Incidence; Meta-Analysis and Systematic Review Study

Research Article

Austin Med Sci. 2023; 8(2): 1077.

The Role of COVID-19 Pandemic on Malaria Incidence; Meta-Analysis and Systematic Review Study

Mahsa Jalili1,2; Fatemeh Sadat Abolhasani3; Hamed Afkhami4,5; Somayeh Sharifi1,2; Ali Noori Zadeh6; Morvarid Shafiei7*

1Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

2Reference Laboratory of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

3Department of Microbiology, Faculty of Biological Sciences, Alzahra University, Tehran, Iran

4Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran

5Department of Medical Microbiology, School of Medicine, Shahed University, Tehran, Iran

6Department of Clinical Biochemistry, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran

7Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran

*Corresponding author: Morvarid Shafiei 7Department of Bacteriology, Pasteur Institute of Iran, Tehran, IR Iran. Tel: +98-9128047530, +98-216411223 Email: [email protected]

Received: August 22, 2023 Accepted: September 29, 2023 Published: October 06, 2023


Background: Today, COVID-19 and malaria are the leading causes of death in the worldwide. Malaria and COVID-19 have common aspects and may be was a high potential for mutual influence. Hence, consequences and outcomes of COVID-19 become very dangerous and problematic. The aim of this study, investigate of the influence of COVID-19 mortality and malaria prevalence by systematic review and meta-analysis study.

Method: We searched authentic research databases by using the following keywords in English language. In additional, for statistical analysis, meta-analysis and random effect model and I2 index were used. Statistical analysis was performed with STAT (version 11.2).

Result: In the present study, nine articles were selected from 1,014 articles that examined co-infection in COVID-19 and malaria. This study revealed that co-infection between malaria and COVID-19 has very interesting and surprising results. OR (odds ratio) =-1.2 (95% CI: -1.8 to -0.6). We encounter high values of I2 in the study (l2=98.549).

Conclusion: People with malaria who show symptoms such as fever should be evaluated by COVID-19 to prevent serious complications. The present study provided information on malaria and COVID-19 co-infection. Nevertheless, further prospective studies are needed to investigate the burden and consequences of COVID-19 in malaria endemic areas.

Keywords: COVID-19; SARS-CoV-2; Malaria; Meta analysis; Systematic Review


Acute respiratory syndrome-coronavirus (SARS-CoV-2) is a viral infection that is considered one of the most persistent, destructive and deadly infectious diseases [1]. On January 30, 2020, the World Health Organization declared the outbreak of the coronavirus as a public health emergency with international concern, and on March 11, 2020, it was recognized as a global pandemic [2]. Nowadays, the SARS-CoV-2 virus, the causative agent of coronavirus disease (COVID-19), has caused more than 690 million cases and 6.8 million deaths globally. The clinical manifestations of the corona virus infectious disease include fever, cough, fatigue, myalgia, headache, shortness of breath and in some cases lead to severe pneumonia and acute respiratory distress syndrome in patients [3]. Furthermore, the effects of the COVID-19 infection can significantly affect other diseases such as malaria. However, malaria and COVID-19 may resemble each other and present similar symptoms such as fever, fatigue and headache, cough, sweating, and breathing problems that are often misdiagnosed [4]. Despite this, malaria is one of the most dangerous and deadly parasitic diseases in the world and is widely distributed in tropical and subtropical regions, especially in Africa and Southeast Asia [5]. Despite being preventable and treatable, the parasitic disease of malaria still has a devastating effect on people's health and livelihood [6]. According to the some reports published by the WHO; this parasitic disease has accounted for a high percentage of deaths in African countries, while only about 3% of malaria cases have been reported in Southeast Asian regions such as India, Indonesia, Bangladesh, Nepal, Thailand, Sri Lanka, Myanmar and the Maldives [7]. Some statistical evidence shows that since the end of August 2020, the incidence rate of the COVID-19 disease in Africa is not high compared to many regions around the world [8]. The relatively low spread of COVID-19 in Africa may depend on host genetic epidemiology and other relevant factors that protect the African population from SARS-CoV-2 infection. Thus, the infectious disease COVID-19 can affects the efforts of health care providers in malaria control and ultimately leads to significant changes in the statistics of malaria patients [9]. Epidemiological analysis of the global malaria situation in the corona virus pandemic helps to understand the dynamics of the changing malaria situation in different continents and helps us to implement control strategies and allocate financial and medical resources [10]. However, there is a significant knowledge gap regarding the co-infection of these two diseases. A better understanding of co-infection may lead to the development of control strategies for different regions. Hence, in this systematic review, we reviewed reports of co-infection with malaria and COVID-19 and assessed aspects such as symptoms, diagnosis and mortality.

Material and Methods

Study Protocol and Registration

This study was conducted in Hamadan University of Medical Sciences, Hamadan, Iran. This review is based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) guidelines was done.

Search Strategy

In this study the reports of co-infection of COVID-19 and malaria in databases including PubMed, Web of Science, and Scopus from the beginning to February 2022 were collected and analyzed and keywords including “COVID-19”, “malaria”, “2019-nCoV”, “Plasmodium falciparum”, “2019 nCoV Infection”, “2019-nCoV”, “Coronavirus Disease-19”, “Coronavirus Disease 19”, “2019 Novel Coronavirus”, “SARS Coronavirus 2”, “SARS-CoV-2” were used.

Also, words “combinations and / or operators” were used as keywords. In this study, only the terms in the Medical Subject (MeSH) headings in the search strategy were used.

Inclusion and Exclusion Criteria

The inclusion criteria in the current study include observational and epidemiological articles such as cross-sectional studies, case-control studies and cohort studies in English that were conducted on the human population and published in relation to the co-infection of COVID-19 and malaria.The study excluded review papers with insufficient data, irrelevant to the subject, authors' comments, authors' corrections, news, letters to the editor, studies with short reports, laboratory studies. Also, in the present study, articles on COVID-19 and unrelated parameters, authors' predictions on COVID-19 models, molecular studies, case reports, systematic or limited studies, community assessment studies, clinical trials, animal studies, and analytical studies were excluded.

Articles Selection

In this study, the initial search of articles was done by two authors (S. SH and M.J). Any initial disagreement about the eligibility of the studies was resolved by discussion among all authors and then agreement between all authors. The authors reviewed the topics, titles, and abstracts of all identified articles. The full text of the articles was evaluated according to the inclusion and exclusion criteria of the present study. Any initial disagreement about the eligibility of the articles was resolved by discussion among all authors. Finally, articles using the STROBE checklist (strengthening the reporting of observational studies in epidemiology) were evaluated. Eventually, articles that received a minimum score of 16 were selected as finalists.

Data Extraction and Data Item

The fallowing data extracted from each study for further analysis included first author, year of publication, place of study including country/ continent, year of study, mean age and standard deviation, number of patients with co-infection, population size of studies including number of case, control, total, male and female in case and control groups, number of patients with SARS-CoV-2, and number of patients infected with Plasmodium spp, P-value and odds ratios and other data (Table 1). Also, all data excluded from the studies were placed in a standard experimental datasheet before further analysis.