Abstract

Research Article

Occurrence, Risk Factors, and Clinical Implications of Malaria–typhoid Co-infection among Febrile Patients Attending Camrail Medical Center, Douala, Cameroon

Njolle Belle Alice, Fankep Dihewou Alphonse Bertin, Mohnchimbare Christina Mbongueh and Kamga Fouamno Henri Lucien*

Published: 04 June, 2026 | Volume 9 - Issue 1 | Pages: 27-33

Background: Malaria and typhoid fever remain major public health problems and important causes of febrile illness in sub-Saharan Africa, particularly in urban settings characterized by poor sanitation, unsafe water supply, overcrowding, and persistent malaria transmission. The clinical manifestations of both diseases frequently overlap, making accurate diagnosis difficult and often leading to empirical treatment, inappropriate antimicrobial use, and delayed patient management. This study assessed the occurrence, associated risk factors, and clinical implications of malaria–typhoid co-infection among febrile patients attending the Camrail Medical Center in Douala, Cameroon. 
Methods: A hospital-based analytical cross-sectional study was conducted among 220 febrile patients recruited systematically at the outpatient department. Data were collected using structured questionnaires, clinical assessment forms, and laboratory investigations. Malaria infection was diagnosed using standard parasitological methods, while typhoid fever was assessed using routine laboratory procedures. Data were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression in SPSS version 25. 
Results: Malaria mono-infection accounted for 31.8% of cases, typhoid mono-infection for 10.9%, and malaria–typhoid co-infection for 15.5%, whereas 41.8% of participants had neither infection. Significant predictors of co-infection included unsafe water sources (AOR = 3.12; p = 0.001), poor food hygiene (AOR = 3.85; p < 0.001), non-use of bed nets (AOR = 2.21; p = 0.021), and exposure to stagnant water (AOR = 2.76; p = 0.004). Co-infected patients experienced significantly more severe clinical manifestations, including high fever, vomiting, diarrhea, abdominal pain, and headache. Age-stratified analysis showed a higher proportion of co-infection among participants aged ≤25 years (18.8%) compared with those aged ≥26 years (12.9%), although the difference was not statistically significant (p = 0.194). Gender-based analysis demonstrated no significant association between sex and infection category (p = 0.606).
Conclusion and recommendations: Malaria–typhoid co-infection remains a significant public health concern in Douala. Integrated diagnostic approaches, improved environmental sanitation, safe water access, food hygiene promotion, and strengthened malaria prevention measures are essential to reducing the burden of co-infection and limiting inappropriate antimicrobial use.

Read Full Article HTML DOI: 10.29328/journal.ijcmbt.1001037 Cite this Article Read Full Article PDF

Keywords:

Malaria; Typhoid fever; Co-infection; Febrile illness; Risk factors; Cameroon; Douala

References

  1. World Health Organization. World malaria report 2024 [Internet]. Geneva: World Health Organization; 2024 [cited Year Month Day]. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024
  2. World Health Organization Regional Office for Africa. Cameroon malaria country profile [Internet]. Brazzaville: WHO Regional Office for Africa; 2024 [cited Year Month Day]. Available from: https://www.afro.who.int/countries/cameroon
  3. Antonio-Nkondjio C, Ndo C, Njiokou F, Bigoga JD, Awono-Ambene P, Etang J, et al. Review of malaria transmission dynamics and vector control in urban settings of Cameroon. Parasit Vectors. 2019;12(1):1-15. Available from: https://doi.org/10.1186/s13071-019-3404-7
  4. Kim JH, Mogasale V, Im J, Ramani E, Marks F. Updated estimates of typhoid fever burden in sub-Saharan Africa. Clin Infect Dis. 2022;75(Suppl 1). Available from: https://doi.org/10.1186/s13071-019-3404-7
  5. Marks F, von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, et al. Incidence of invasive Salmonella disease in sub-Saharan Africa. Clin Infect Dis. 2017;65(Suppl 1). Available from: https://doi.org/10.1093/cid/cix393
  6. Akoachere JFTK, Tanih NF, Ndip LM, Ndip RN. Phenotypic characterization of Salmonella Typhi in Cameroon and associated environmental risk factors. BMC Infect Dis. 2019;19(1):1-9. Available from: https://doi.org/10.1093/cid/cix393
  7. Uneke CJ. Concurrent malaria and typhoid fever in the tropics: the diagnostic challenges and public health implications. J Vector Borne Dis. 2008;45(2):133-142. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743161/
  8. D'Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, et al. Beyond malaria: causes of fever in outpatient Tanzanian children. N Engl J Med. 2014;370(9):809-817. Available from: https://doi.org/10.1056/NEJMoa1214482
  9. Anjorin AA, Abioye AI, Adegoke AA, Adeyemi OO. Febrile illness management and antimicrobial misuse in sub-Saharan Africa. Trop Med Infect Dis. 2023;8(2):85-96. Available from: https://doi.org/10.3390/tropicalmed8020085
  10. Olopoenia LA, King AL. Widal agglutination test—100 years later: still plagued by controversy. Postgrad Med J. 2000;76(892):80-84. Available from: https://doi.org/10.1136/pmj.76.892.80
  11. Sohanang Nodem M, Tchouangueu TF, Ndzi ES. Prevalence and determinants of malaria-typhoid co-infection among febrile patients in Adamawa Region, Cameroon. BMC Infect Dis. 2023;23(1):633-642. Available from: https://doi.org/10.1186/s12879-023-08533-4
  12. Netongo PM, Tchoutang AM, Eric MB, Tepa A, Nzuno MC, Kamdem SD. Malaria and typhoid fever coinfection among febrile patients attending a health facility in Yaoundé, Cameroon: a cross-sectional study. J Parasitol Res. 2025;2025:9977704. Available from: https://doi.org/10.1155/japr/9977704
  13. Kothari CR. Research methodology: methods and techniques. 2nd ed. New Delhi: New Age International Publishers; 2004. Available from: https://arunodayauniversity.ac.in/wp-content/uploads/2025/01/Research-Methodology-Methods-and-Techniques-Kothari.pdf
  14. World Health Organization. Guidelines for the treatment of malaria. 3rd ed. Geneva: World Health Organization; 2015. Available from: https://www.who.int/publications/i/item/9789241549127
  15. Cunnington AJ, de Souza JB, Walther M, Riley EM. Malaria impairs resistance to Salmonella through heme- and heme oxygenase-dependent dysfunctional granulocyte mobilization. Nat Med. 2012;18(1):120-127. Available from: https://doi.org/10.1038/nm.2601
  16. Scott JAG, Berkley JA, Mwangi I, Ochola L, Uyoga S, Macharia A, et al. Relation between falciparum malaria and bacteremia in Kenyan children. Lancet. 2011;378(9799):1316-1323. Available from: https://doi.org/10.1016/S0140-6736(11)60888-X

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