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Table 1 Studies reporting malaria and NTS bacteraemia in children

From: The association between malaria and non-typhoid Salmonella bacteraemia in children in sub-Saharan Africa: a literature review

Study site n Age Study population NTS bacteraemia diagnosis Malaria diagnosis Major findings and comments
Burkina Faso (rural) [68] 711 <15 y All admitted children with measured fever or clinical signs of severe illness BC M, RDT RDT positivity rate was higher in those with NTS bacteraemia (81%) compared to those with other bacterial infections (31%) (p <0.001)
Tanzania (rural + urban) [16] 3,639 + 457 2 m-13 y Admitted children with measured fever or history of fever BC M, RDT Children with recent malaria had higher rates of NTS bacteraemia compared to those without recent malaria (adjusted OR =4.13(95% CI = 2.66-6.44)
DRC (mainly rural) [69] 3,311 <=14 y and adults Signs suggestive of bacteraemia or focal signs BC M and/or RDT Majority of children (82%) with Salmonella had falciparum malaria infection, NTS not seasonal, comparison group not mentioned
Kenya (rural + urban) [5] 5,716 - Children with fever, severe respiratory illness, admitted patients BC M Evidence of correlation between positive malaria cases and NTS bacteraemia, no clear seasonal pattern, no comparison group
Kenya (rural) [14] 292 3 m-13 y Cases: admitted children whose BC grew pathogenic bacteria BC M or RDT Those with haemozoin in blood leucocytes were more likely to have NTS bacteraemia compared to those without haemozoin OR 16.5 (95% CI = 3.44-79.3)
Controls: healthy children individually matched to cases on age, sex and residential location
Tanzania (rural) [18] 6,836 2 m-14 y History of fever, clinical signs of severe malaria, fever surveillance BC M and RDT Evidence of reduction in NTS bacteraemia associated with severe malaria reduction
Kenya (rural) [58] 585 1-36 m Children with malaria aged 1–36 m BC M NTS was the most common isolate in children with malaria, comparison group not mentioned
DRC (rural) [20] 1,528 - Febrile children admitted, hypothermia, other clinical signs BC M 40% of NTS bacteraemia had malaria co-infection compared to 1% for typhoid bacteraemia, no seasonality of NTS
Tanzania (rural) [6] 1,502 2 m-14 y Fever + signs of severity BC M or RDT 73% with NTS infection had malaria compared to 21% for those with typhoid fever (p < 0.01) and compared to 40% for other bacteraemia (p < 0.01) - association more for recent than current malaria
Ghana (rural) [64] 948, 1,032 cultures 2 m-5 y Children 2 m-5 y admitted BC - 24% of children with NTS bacteraemia had malaria infection compared to 18% for other bacteraemia (S. pneumoniae), no significance test mentioned
Tanzania (rural) [4] 3,639 2 m-12 y Fever, non-infectious cause of fever excluded BC M, RDT 52% NTS in slide positive compared to 45% in slide negative, no significance test mentioned
The Gambia (rural + urban) [19] - - - BC - NTS reduction associated with malaria reduction
Kenya (rural) [22] 3,068a - Children with clinical suspicion of severe malaria and culture results available BC M NTS more in parasitaemic children compared to non-parasitaemic children (p = 0.05)
Mozambique (rural) [104] 1,780 <5 y Children <5 y with severe malaria BC M NTS among frequent bacteria in patients with severe malaria but no evidence of association
Mozambique (rural) [26] 23,686 <15 y Children <15 y admitted BC M About 44% of bacteraemic patients had malaria co-infection. No 7comparison with control and no mention of NTS specifically
Nigeria (urban) [118] 235 0-45 m Children with fever with or without other symptoms BC M Co-infection with S. enteritidis and malaria present, no mention of control group
The Gambia (urban) [41] 871 2 m-80 y Clinically ill patients BC M NTS 20% in slide positive compared to 57% in slide negative but not statistically significant, few cases of NTS
Tanzania (urban) [65] 1,787 0-7 y Clinical suspicion of systemic infection BC M No evidence of association between malaria and NTS
Malawi (urban) [24] 1,388 ≥6 m Children with severe malaria and BC results BC M NTS bacteraemia higher in those with severe malaria anaemia (7.6%) compared to other severe malaria entities [CM + SMA] (4.7%) compared to CM (3.0%) p <0.0001]
Kenya (urban) [66] 332 4 w-84 m NTS bacteraemia or gastroenteritis BC M More than half of malaria confirmed children had NTS, no seasonal pattern. Proportion in control group not mentioned
The Gambia (rural) [27] 330 2-29 m Ill children admitted BC M or RDT No difference in proportion of malaria infection between those with NTS infections compared to other infections
Kenya (rural) [15] 166 <13 y Children with Salmonella bacteraemia BC M or RDT More NTS in rainy season; recent malaria (RDT positive) but not current malaria was a risk factor for NTS bacteraemia compared to non-bacteraemic patients (OR = 1.8, 95% CI 1.0-3.1)
Kenya (rural) [43] 2,830 >3 y Children admitted for malaria (parasite positive) and for other illnesses (parasite negative) BC M Salmonella spp. bacteraemia more common in those parasite positive. No specific mention of NTS bacteraemia
DRC (rural) [23] 779 1 m-15 y 8 m Children with and without fever - M A positive blood smear associated with bacteraemia (including NTS). There was enough evidence that 25% of malaria positive had bacteraemia compared to 14% for malaria negative
Malawi (urban) [13] 2,123 <1-15 y Children with clinical suspicion bacteraemia (febrile) and low level parasitaemia or after anti-malarial BC M Children with NTS bacteraemia more likely to have parasitaemia compared to other bacteraemia (RR 2.4, 95% CI 1.46-3.96), NTS increase in rainy season
Malawi (urban) [21] 299 0-14 y Sick children with NTS bacteraemia, focal sepsis excluded BC M NTS increase in rainy season, coincides with malaria, NTS associated with severe anaemia, malaria parasitaemia compared to other causes of bacteraemia
Kenya (rural) [63] 783 - Children with severe malaria BC M 6 out of 540 children with severe malaria (and BC results available) had NTS, bacteraemia common in children with severe malaria
DRC (rural) [29] 120 1-15 y Clinically ill in wards and outpatient BC M Concurrent malaria parasitaemia and bacteraemia in 25% of cases
The Gambia (rural) [70] 2,898 <5 y Clinical signs of pneumonia, meningitis, septicaemia BC M Salmonella bacteraemia increased during rainy season, those with malaria pigment more likely to be found in those with Salmonella infections compared to other infections (RR = 4.05, 95% 1.15-14.42), comparison not done specifically for NTS
Nigeria (rural + urban) [67] 56 <5 y Case series with positive BC, referred BC M Increase in cases of paratyphoid fever during rainy season
The Gambia (urban) [17] 247   Clinically ill children with positive blood culture BC M Patients with NTS bacteraemia had higher prevalence of malaria parasitaemia compared to other bacteraemic patients (X2 = 9, p < 0.01)
  1. All health facility-based studies in Table 1.
  2. BC = blood culture, M = microscopy, RDT = rapid diagnostic test, RR = relative risk, CM + SMA = cerebral malaria and severe malarial anaemia.
  3. aThese children were compared to 592 controls from the community.