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Research article - Peer-reviewed, 2022

A systematic review and meta-analysis of the aetiological agents of non-malarial febrile illnesses in Africa

Wainaina, Martin; Attuy Vey da Silva, David; Dohoo, Ian; Mayer-Scholl, Anne; Roesel, Kristina; Hofreuter, Dirk; Roesler, Uwe; Lindahl, Johanna; Bett, Bernard; Al Dahouk, Sascha


The awareness of non-malarial febrile illnesses (NMFIs) has been on the rise over the last decades. Therefore, we undertook a systematic literature review and meta-analysis of causative agents of non-malarial fevers on the African continent.

We searched for literature in African Journals Online, EMBASE, PubMed, Scopus, and Web of Science databases to identify aetiologic agents that had been reported and to determine summary estimates of the proportional morbidity rates (PMr) associated with these pathogens among fever patients.

A total of 133 studies comprising 391,835 patients from 25 of the 54 African countries were eligible. A wide array of aetiologic agents were described with considerable regional differences among the leading agents. Overall, bacterial pathogens tested from blood samples accounted for the largest proportion. The summary estimates from the meta-analysis were low for most of the agents. This may have resulted from a true low prevalence of the agents, the failure to test for many agents or the low sensitivity of the diagnostic methods applied. Our meta-regression analysis of study and population variables showed that diagnostic methods determined the PMr estimates of typhoidal Salmonella and Dengue virus. An increase in the PMr of Klebsiella spp. infections was observed over time. Furthermore, the status of patients as either inpatient or outpatient predicted the PMr of Haemophilus spp. infections.

The small number of epidemiological studies and the variety of NMFI agents on the African continent emphasizes the need for harmonized studies with larger sample sizes. In particular, diagnostic procedures for NMFIs should be standardized to facilitate comparability of study results and to improve future meta-analyses. Reliable NMFI burden estimates will inform regional public health strategies.

Published in

PLoS Neglected Tropical Diseases
2022, volume: 16, number: 1, article number: e0010144

Authors' information

Wainaina, Martin
International Livestock Research Institute (ILRI)
Attuy Vey da Silva, David
Free University of Berlin
Dohoo, Ian
University of Prince Edward Island
Mayer-Scholl, Anne
Federal Institute for Risk Assessment
Roesel, Kristina
International Livestock Research Institute (ILRI)
Hofreuter, Dirk
German Federal Institute for Risk Assessment (BfR)
Roesler, Uwe
Free University of Berlin
Swedish University of Agricultural Sciences, Department of Clinical Sciences
International Livestock Research Institute (ILRI)
Uppsala University
Bett, Bernard
International Livestock Research Institute (ILRI)
Al Dahouk, Sascha
RWTH Aachen University Hospital

Associated SLU-program


UKÄ Subject classification

Microbiology in the medical area

Publication Identifiers


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