Reassessing Malaria and Typhoid Co-Infection in Africa

Malaria and typhoid fever remain two of the most significant infectious diseases in Africa, contributing substantially to morbidity, mortality, and socioeconomic burden across the continent. Their overlapping geographic distribution, shared environmental risk factors, and similar clinical manifestations have led to a high burden of suspected and confirmed co-infections. However, the true epidemiology of malaria–typhoid co-infection remains poorly defined, largely due to diagnostic limitations, over-reliance on clinical symptoms, and the widespread use of poorly specific tools such as the Widal test. This review critically examines the current understanding of malaria and typhoid fever co-infection in Africa, highlighting the biological, environmental, and health-system factors that drive their coexistence. It explores the challenges associated with accurate diagnosis, including symptom overlap, inadequate laboratory capacity, co-circulation of other febrile illnesses, and the persistent use of suboptimal diagnostic methods. The review also assesses the consequences of misdiagnosis, such as inappropriate treatment, antimicrobial resistance, increased disease severity, and prolonged hospital stay. By synthesizing available evidence, we illuminate key knowledge gaps and underscore the need for integrated surveillance systems, improved diagnostic algorithms, point-of-care tools with higher sensitivity and specificity, and strengthened health-care infrastructure. Finally, we propose context-appropriate strategies for prevention, early detection, and effective management of co-infections in African settings.