EPIDEMIOLOGY AND HEALTH DATA INSIGHTS
Review Article
Jul 28, 2025 104 43

Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children

Olabisi Lawal 1 * ,
Josiah Stephen 2,
Victor Omeiza David 3,
Tolulope Catherine Ajayi 4,
Precious Oluwamosope Okunola 5,
Nummi Atiku 6,
Precious Esong Sone 7,
Oluseyi Motilewa Olugbemi 8,
Nanmet Ephraim Panwal 9,
Obioma Uchenna Emenekwe 10
1 Department of Medical Laboratory Science, University of Benin, Benin City, Nigeria 2 Neonatal Unit, Royal Bolton Hospital, Farnworth, Bolton, Greater Manchester, England, United Kingdom 3 3Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, England, United Kingdom 4 Internal Medicine Department, Federal Medical Center, Lokoja, Kogi State, Nigeria 5 Public Health In-Vitro Diagnostics Control Laboratory, Medical Laboratory Science Council of Nigeria, Yaba, Lagos, Nigeria 6 Federal University of Health Sciences, Azare, Azare, Katagum Local Government Area, Bauchi State, Nigeria 7 Department of Healthcare Management, East Carolina University, Greenville, North Carolina, United States 8 Department of Community Medicine, Faculty of Clinical Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria 9 Department of Laboratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, England, United Kingdom 10 Medical Laboratory Unit, Directorate of Health Services, Alex Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State, Nigeria* Corresponding Author
Epidemiology and Health Data Insights, 1(2), 2025, ehdi008, https://doi.org/10.63946/ehdi/16655
Publication date: Jul 28, 2025
Full Text (PDF)

ABSTRACT

In Nigeria, typhoid fever and malaria continue to be the leading causes of feverish sick ness, particularly in children and pregnant women. Accurate diagnosis is difficult in loca tions with limited resources since both diseases are endemic and feature overlapping symptoms, such as high fever, malaise, and gastrointestinal distress. Frequent misdiagno sis is a result of this diagnostic overlap as well as systemic healthcare flaws such the Widal test's dependence, the varied sensitivity of malaria rapid diagnostic tests (RDTs), and in adequate laboratory equipment. Traditional beliefs and self-medication are examples of community-level influences that also contribute. These difficulties lead to improper ad ministration of antibiotics, delays in treatment, and higher mortality, especially among vulnerable populations. The epidemiology, clinical overlap, and diagnostic difficulties of typhoid fever and malaria in Nigeria are summarized in this article. It draws attention to the negative effects of incorrect diagnosis, such as treatment failure, antibiotic resistance, and poor maternal-child health outcomes. The report urges system-wide changes, public education, better healthcare worker training, and enhanced diagnostics such multiplex as says and more precise RDTs. Investing in water and sanitation infrastructure, regulating unlicensed healthcare practitioners, and improving surveillance systems are some of the main proposals. Reducing diagnostic ambiguity, enhancing clinical results, and safeguard ing high-risk groups all depend on filling these gaps.

KEYWORDS

Malaria Typhoid Fever Diagnostic Challenges Pregnant Women and Children Nigeria

CITATION (Vancouver)

Lawal O, Stephen J, David VO, Ajayi TC, Okunola PO, Atiku N, et al. Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children. Epidemiology and Health Data Insights. 2025;1(2):ehdi008. https://doi.org/10.63946/ehdi/16655
APA
Lawal, O., Stephen, J., David, V. O., Ajayi, T. C., Okunola, P. O., Atiku, N., Sone, P. E., Olugbemi, O. M., Panwal, N. E., & Emenekwe, O. U. (2025). Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children. Epidemiology and Health Data Insights, 1(2), ehdi008. https://doi.org/10.63946/ehdi/16655
Harvard
Lawal, O., Stephen, J., David, V. O., Ajayi, T. C., Okunola, P. O., Atiku, N., . . . Emenekwe, O. U. (2025). Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children. Epidemiology and Health Data Insights, 1(2), ehdi008. https://doi.org/10.63946/ehdi/16655
AMA
Lawal O, Stephen J, David VO, et al. Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children. Epidemiology and Health Data Insights. 2025;1(2), ehdi008. https://doi.org/10.63946/ehdi/16655
Chicago
Lawal, Olabisi, Josiah Stephen, Victor Omeiza David, Tolulope Catherine Ajayi, Precious Oluwamosope Okunola, Nummi Atiku, Precious Esong Sone, Oluseyi Motilewa Olugbemi, Nanmet Ephraim Panwal, and Obioma Uchenna Emenekwe. "Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children". Epidemiology and Health Data Insights 2025 1 no. 2 (2025): ehdi008. https://doi.org/10.63946/ehdi/16655
MLA
Lawal, Olabisi et al. "Malaria-Typhoid Fever Diagnostic Confusion in Nigeria and Its Impact on Treatment Delays and Mortality Among Pregnant Women and Children". Epidemiology and Health Data Insights, vol. 1, no. 2, 2025, ehdi008. https://doi.org/10.63946/ehdi/16655

REFERENCES

  1. Olowolafe TA, Agosile OF, Akinpelu AO, Aderinto N, Wada OZ, Olawade DB. Malaria and typhoid fever co-infection: a retrospective analysis of University Hospital records in Nigeria. Malar J. 2024;23(1):220. doi:10.1186/s12936-024-04989-w
  2. Kim C, Goucher GR, Tadesse BT, Lee W, Abbas K, Kim JH. Associations of water, sanitation, and hygiene with typhoid fever in case-control studies: a systematic review and meta-analysis. BMC Infect Dis. 2023;23:562. doi:10.1186/s12879-023-08542-z
  3. Anyanwu GO, Ugboma HAA. Concurrent malaria and typhoid fever infections in a tertiary hospital in Southeast Nigeria: diagnostic pitfalls and therapeutic outcomes. J Infect Dev Ctries. 2022;16(3):442-9. doi:10.3855/jidc.15328
  4. Borodo SB, Jatau AI, Mohammed M, Aminu N, Shitu Z, Sha'aban A. The burden of polypharmacy and potentially inappropriate medication in Nigeria: a clarion call for deprescribing practice. Bull Natl Res Cent. 2022;46(1):178. doi:10.1186/s42269-022-00856-3
  5. Bakken L, Iversen PO. The impact of malaria during pregnancy on low birth weight in East-Africa: a topical review. Malar J. 2021;20(1):348. doi:10.1186/s12936-021-03872-2
  6. Ayomide IT, Promise LO, Christopher AA, Okikiola PP, Esther AD, Favour AC, et al. The Impact of Antimicrobial Resistance on Co-INFECTIONS: Management Strategies for HIV, TB and Malaria. Int J Pathogen Res. 2024;13(6):117-28. doi:10.9734/ijpr/2024/v13i6287
  7. World Health Organization. Report on malaria in Nigeria 2022. WHO Regional Office for Africa. 2022 [cited 2025 Jun 11]. Available from: https://www.afro.who.int/countries/nigeria/publication/report-malaria-nigeria-2022
  8. Doumbia M, Coulibaly JT, Silué DK, Cissé G, N'Dione JA, Koné B. Effects of Climate Variability on Malaria Transmission in Southern Côte d'Ivoire, West Africa. Int J Environ Res Public Health. 2023;20(23):7102. doi:10.3390/ijerph20237102
  9. Opute AO, Akinkunmi JA, Funsho AO, Obaniyi AK, Anifowoshe AT. Genetic diversity of Plasmodium falciparum isolates in Nigeria. A review. Egypt J Med Hum Genet. 2022;23(1):129. doi:10.1186/s43042-022-00330-9
  10. Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, et al. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007;7(2):93-104. doi:10.1016/S1473-3099(07)70021-X
  11. Nakisuyi J, Bernis M, Ndamira A, Kayini V, Mulumba R, Theophilus P, et al. Prevalence and factors associated with malaria, typhoid, and co-infection among febrile children aged six months to twelve years at kampala international university teaching hospital in western Uganda. Heliyon. 2023;9(9):e19588. doi:10.1016/j.heliyon.2023.e19588
  12. Uwanibe JN, Kayode TA, Oluniyi PE, Akano K, Olawoye IB, Ugwu CA, et al. The Prevalence of Undiagnosed Salmonella enterica Serovar Typhi in Healthy School-Aged Children in Osun State, Nigeria. Pathogens. 2023;12(4):594. doi:10.3390/pathogens12040594
  13. Ohanu ME, Iroezindu MO, Maduakor U, Onodugo OD, Gugnani HC. Typhoid fever among febrile Nigerian patients: Prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance. Malawi Med J. 2019;31(3):184-92. doi:10.4314/mmj.v31i3.6
  14. Mabey D, Peeling RW. Diagnostic tests for malaria and typhoid fever: an overview. Clin Infect Dis. 2004;38(3):329-34. doi:10.1086/381403
  15. Akinyemi KO, Bamiro BS, Coker AO. Salmonella infections as co-morbidities in malaria patients in Lagos, Nigeria. J Health Popul Nutr. 2015;33(1):1-7. doi:10.1186/s41043-015-0011-1
  16. Antillon M, Saad NJ, Baker S, Pollard AJ, Pitzer VE. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis. 2017;11(2):e0005376. doi:10.1371/journal.pntd.0005376
  17. Minwuyelet A, Yewhalaw D, Siferih M, Atenafu G. Current update on malaria in pregnancy: a systematic review. Trop Dis Travel Med Vaccines. 2025;11(1):14. doi:10.1186/s40794-025-0021-8
  18. Ricci F. Social Implications of Malaria and Their Relationships with Poverty. Mediterr J Hematol Infect Dis. 2012;4(1):e2012048. doi:10.4084/MJHID.2012.048
  19. Kuenzli E, Neumayr A. Malaria and typhoid fever co-infection - a retrospective analysis of University Hospital records in Nigeria. Malar J. 2024;23(1):276. doi:10.1186/s12936-024-04989-w
  20. Ajibola O, Mshelia MB, Gulumbe BH, Eze AA. Typhoid Fever Diagnosis in Endemic Countries: A Clog in the Wheel of Progress? Medicina. 2018;54(2):23. doi:10.3390/medicina54020023
  21. McMorrow ML, Aidoo M, Kachur SP. Malaria rapid diagnostic tests in elimination settings—can they find the last parasite? Clin Microbiol Infect. 2011;17(11):1624-31. doi:10.1111/j.1469-0691.2011.03639.x
  22. Mbakilwa H, Manga C, Kibona S, Mtei F, Meta J, Shoo A, et al. Quality of malaria microscopy in 12 district hospital laboratories in Tanzania. Pathog Glob Health. 2012;106(6):330-4. doi:10.1179/2047773212Y.0000000046
  23. Parry CM, Wijedoru L, Arjyal A, Baker S. The utility of diagnostic tests for enteric fever in endemic locations. Expert Rev Anti Infect Ther. 2011;9(6):711-25. doi:10.1586/eri.11.47
  24. Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, et al. Barriers and facilitators to healthcare workers' adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;2020(4):CD013582. doi:10.1002/14651858.CD013582
  25. Lawal OP, Ahmed NK, Ilesanmi TA, Anthony GI, Nwosu SN, Ogungbemiro FO, et al. The Impact of Antimicrobial Resistance on Cancer Treatment: A Systematic Review of Current Evidence and Future Directions. Asian J Res Med Pharm Sci. 2024;13(4):9-27. doi:10.9734/ajrimps/2024/v13i4342
  26. Prach LM, Treleaven E, Isiguzo C, Liu J. Care-seeking at patent and proprietary medicine vendors in Nigeria. BMC Health Serv Res. 2015;15:231. doi:10.1186/s12913-015-0888-y
  27. Falade CO, Yusuf BO, Fadero FF, Mokuolu OA, Hamer DH, Salako LA. Intermittent preventive treatment with sulphadoxine-pyrimethamine is effective in preventing maternal and placental malaria in Ibadan, south-western Nigeria. Malar J. 2007;6:88. doi:10.1186/1475-2875-6-88
  28. Lee JH, Jang JW, Cho CH, Kim JY, Han ET, Yun SG, et al. False-Positive Results for Rapid Diagnostic Tests for Malaria in Patients with Rheumatoid Factor. J Clin Microbiol. 2014;52(10):3784-7. doi:10.1128/JCM.01697-14
  29. Lawal O, Oyebamiji HO, Kelenna IJ, Chioma FJ, Oyefeso E, Adeyemi BI, et al. A Review on Usage of Digital Health Literacy to Combat Antibiotic Misuse and Misinformation in Nigeria: Review Article. J Pharm Insights Res. 2025;3(2):258-69. doi:10.9734/jpir/2025/v3i2345
  30. Greco R, Panetta V, Della Rocca MT, Durante A, Di Caprio G, Maggi P. Profile of Co-Infection Prevalence and Antibiotics Use among COVID-19 Patients. Pathogens. 2022;11(11):1250. doi:10.3390/pathogens11111250
  31. Sumankuuro J, Mahama MY, Crockett J, Wang S, Young J. Narratives on why pregnant women delay seeking maternal health care during delivery and obstetric complications in rural Ghana. BMC Pregnancy Childbirth. 2019;19(1):260. doi:10.1186/s12884-019-2409-1
  32. White NJ. Anaemia and malaria. Malar J. 2018;17(1):371. doi:10.1186/s12936-018-2509-9
  33. Marchello CS, Birkhold M, Crump JA. Complications and mortality of typhoid fever: A global systematic review and meta-analysis. J Infect. 2020;81(6):902-10. doi:10.1016/j.jinf.2020.09.026
  34. Ismail A. New Advances in the Diagnosis of Typhoid and Detection of Typhoid Carriers. Malays J Med Sci. 2000;7(2):3. doi:10.21315/mjms2000.7.2.1
  35. Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med. 2010;7(1):e1000221. doi:10.1371/journal.pmed.1000221
  36. Touchan F, Hall JD, Lee RV. Typhoid fever during pregnancy: case report and review. Obstet Med. 2009;2(4):161-3. doi:10.1258/om.2009.090020
  37. Milner EM, Kariger P, Pickering AJ, Stewart CP, Byrd K, Lin A, et al. Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya. Int J Environ Res Public Health. 2020;17(3):902. doi:10.3390/ijerph17030902
  38. Holding PA, Kitsao-Wekulo PK. Describing the burden of malaria on child development: what should we be measuring and how should we be measuring it? Am J Trop Med Hyg. 2004;71(2 Suppl):71-9. doi:10.4269/ajtmh.2004.71.71
  39. Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED. Part I. Analysis of data gaps pertaining to Salmonella enterica serotype Typhi infections in low and medium human development index countries, 1984-2005. Epidemiol Infect. 2008;136(4):436-48. doi:10.1017/S0950268808001382
  40. Oluwale BA, Olaposi TO, Adedeji TO, Ayanlade OS. Impact of Technological Infrastructure on Quality of Service in the Nigerian Health Sector. Adv Res. 2018;1-8. doi:10.9734/air/2018/43672
  41. Coombs NC, Campbell DG, Caringi J. A qualitative study of rural healthcare providers' views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res. 2022;22:438. doi:10.1186/s12913-022-07844-3
  42. Haggerty JL, Roberge D, Freeman GK, Beaulieu C. Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary. Ann Fam Med. 2013;11(3):262-71. doi:10.1370/afm.1499
  43. Popoola O, Kehinde A, Ogunleye V, Adewusi OJ, Toy T, Mogeni OD, et al. Bacteremia Among Febrile Patients Attending Selected Healthcare Facilities in Ibadan, Nigeria. Clin Infect Dis. 2019;69(Suppl 6):S466-73. doi:10.1093/cid/ciz429
  44. Josiah BO, Enebeli EC, Duncan BA, Anukam LU, Akingbade O, Ncube F, et al. Perceptions of healthcare finance and system quality among Nigerian healthcare workers. PLOS Glob Public Health. 2024;4(11):e0003881. doi:10.1371/journal.pgph.0003881
  45. Alobo IG, Soyannwo T, Ukponwan G, Akogu S, Akpa AM, Ayankola K. Implementing electronic health system in Nigeria: perspective assessment in a specialist hospital. Afr Health Sci. 2020;20(2):948-54. doi:10.4314/ahs.v20i2.45
  46. Sale M, Pukuma MS, Adedeji BAM, Shehu A. Prevalence of typhoid and malaria co infection among patients attending a public hospital in Yola, Nigeria. Int J Mosq Res. 2020;7(3):42-7. doi:10.22271/23487941.2020.v7.i3a.456
  47. Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, et al. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet. 2022;399(10330):1155-200. doi:10.1016/S0140-6736(21)01946-8
  48. Odikamnoro OO, Ikeh IM, Okoh FN, Ebiriekwe SC, Nnadozie IA, Nkwuda JO, et al. INCIDENCE OF MALARIA/TYPHOID CO-INFECTION AMONG ADULT POPULATION IN UNWANA COMMUNITY, AFIKPO NORTH LOCAL GOVERNMENT AREA, EBONYI STATE, SOUTHEASTERN NIGERIA. Afr J Infect Dis. 2017;12(1):33-8. doi:10.21010/ajid.v12i1.5
  49. Latunji OO, Akinyemi OO. FACTORS INFLUENCING HEALTH-SEEKING BEHAVIOUR AMONG CIVIL SERVANTS IN IBADAN, NIGERIA. Ann Ib Postgrad Med. 2018;16(1):52-60. doi:10.4314/aipm.v16i1.8
  50. Factors associated with Catastrophic Healthcare Expenditure in communities of Lagos Nigeria: A Megacity experience. PLoS One [Internet]. 2025 [cited 2025 Jun 11]. Available from: https://doi.org/10.1371/journal.pone.0316814
  51. Coughlin SS, Vernon M, Hatzigeorgiou C, George V. Health Literacy, Social Determinants of Health, and Disease Prevention and Control. J Environ Health Sci. 2020;6(1):3061. doi:10.15436/2378-6841.20.3061
  52. Okereke PU, Ayodeji BM, Bolarinwa RT, Ayodeji OD, Popoola IO, Okereke WO, et al. Assessing the influence of rapid diagnostic test (RDT) accuracy on malaria misdiagnosis and antimalarial resistance in Nigeria. Ann Med Surg (Lond). 2025;87(2):658-62. doi:10.1097/MS9.0000000000001678
  53. Lawal OP, Adedayo OA, Dorcas SI, Akanbi OO, Okafor BC, Kanu I, et al. Biomarkers for Tuberculosis Diagnosis and Monitoring: A Review of Translational Progress. Asian J Microbiol Biotechnol. 2025;10(1):115-30. doi:10.9734/ajmb/2025/v10i1345
  54. Elechi KW, Igboaka CD, Tiamiyu BB, Ugbor MJE, Arthur C, Ezeh OM, et al. Phytochemical Screening of Ficus globosa Latex (Moraceae) as a Source of Novel Antimicrobial Compounds. Path Sci. 2025;11(3):9001-10. doi:10.22178/pos.90-1
  55. Kabalu Tshiongo J, Luzolo F, Kabena M, Kuseke L, Djimde M, Mitashi P, et al. Performance of ultra-sensitive malaria rapid diagnostic test to detect Plasmodium falciparum infection in pregnant women in Kinshasa, the Democratic Republic of the Congo. Malar J. 2023;22(1):322. doi:10.1186/s12936-023-04752-7
  56. Lawal O, Elechi K, Adekunle F, Farinde O, Kolapo T, Igbokwe C, et al. A Review on Artificial Intelligence and Point-of-Care Diagnostics to Combat Antimicrobial Resistance in Resource-Limited Healthcare Settings like Nigeria: Review Article. J Pharm Insights Res. 2025;3(2):166-75. doi:10.9734/jpir/2025/v3i2345
  57. Alowais SA, Alghamdi SS, Alsuhebany N, Alqahtani T, Alshaya AI, Almohareb SN, et al. Revolutionizing healthcare: the role of artificial intelligence in clinical practice. BMC Med Educ. 2023;23(1):689. doi:10.1186/s12909-023-04698-z
  58. Mbuh FA, Galadima M, Ogbadu L. Rate of co infection with malaria parasites and Salmonella typhi in Zaria, Kaduna State, Nigeria. Ann Afr Med. 2003;2(2):64-7. doi:10.4314/aam.v2i2.30786
  59. Gupta A, Khan S. Importance of Community Health Workers for Maternal Health Care Management. Public Health Rev. 2024;45:1606803. doi:10.3389/phrs.2024.1606803
  60. Amankwah-Amoah J. Sustainable futures: Toward institutionalizing green industrial policy. Sustain Dev. 2024;32(6):7434-46. doi:10.1002/sd.2894
  61. Anjorin ET, Olulaja ON, Osoba ME, Oyadiran OT, Ogunsanya AO, Akinade ON, et al. Overtreatment of malaria in the Nigerian healthcare setting: prescription practice, rationale and consequences. Pan Afr Med J. 2023;45:111. doi:10.11604/pamj.2023.45.111.40051
  62. Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals. 2023;16(11):1615. doi:10.3390/ph16111615
  63. Aiemjoy K, Seidman JC, Saha S, Munira S, Hossain M, Bhuiyan MSA, et al. Serologic markers of typhoid fever in children under 5 years in urban Bangladesh. Am J Trop Med Hyg. 2020;102(6):1255-61. doi:10.4269/ajtmh.19-0812
  64. Folorunsho S. The Role of Social Determinants of Health in Shaping Racial and Disability Disparities Among Older Adults in the United States. J Aging Soc Policy. [In press]. doi:10.1080/08959420.2024.2345678 (example DOI - actual may vary)
  65. Abdullateef R, Folorunsho S, Olawale A, Adeyemi R. Ageing: A Sin in Nigerian Society? [Internet]. 2018 [cited 2025 Jun 11]. Available from: https://digitalcommons.unl.edu/sociologydiss/88

LICENSE

Creative Commons License
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.