Malaria and coinfections: Challenges for disease control in Sub-Saharan Africa

tuberculosis (TB) and neglected infectious diseases (NIDs) worldwide affect 365 million, 38 million, 2 billion and 1 billion people respectively, per year. 1,2 In Sub-Saharan Africa, where most of these infections occur, there is a high likelihood of individuals being infected with two or more of these diseases contemporaneously. This is often related to poverty and suitable environment for these pathogens to thrive and spread. Poor living conditions expose the inhabitants to higher infection risks and transmission of a variety of infectious diseases and possible coinfections. For instance in Kenya, more malaria deaths occur in regions with elevated HIV rates3. In patients with coinfections the real causes of mortality are often obscure due to overlapping symptoms. In communities with high malaria and HIV prevalence, the occurrence of death is often attributed to spiritual causes, for example in Luo community (Kenya) there is a common believe that death is caused by chira, a form of bad omen. Auma, a fish monger who lives along the shores of Lake Victoria and had lost her husband to AIDS said “my family has not taken any meal for two days, my child is sick of malaria and my husband died last year, its all because of chira. I don’t have money for drugs and am afraid my child may also succumb to chira”. Coinfections have much influence on the immune competence, vaccination response, treatment efficacy, correct diagnosis and pathologies of the involved diseases especially anaemia.4 This is especially important during pregnancy, causing increased anemia, low birth weight, still births and adverse clinical outcomes