Multinomial logistic model for coinfection diagnosis between arbovirus and malaria in Kedougou

TL;DR

This study develops a multinomial logistic model using patient data from Kedougou, Senegal, to improve diagnosis of coinfection between malaria and arboviruses, considering symptom overlap and immunity factors.

Contribution

It introduces a novel multinomial logistic model that identifies key variables for diagnosing coinfection and differentiating between malaria and arboviral diseases in an endemic region.

Findings

Duration of illness >3 days and age >10 years suggest arboviral infection.

High body temperature and nausea/vomiting indicate malaria during the rainy season.

Model helps estimate coinfection probabilities based on clinical variables.

Abstract

In tropical regions, populations continue to suffer morbidity and mortality from malaria and arboviral diseases. In Kedougou (Senegal), these illnesses are all endemic due to the climate and its geographical position. The co-circulation of malaria parasites and arboviruses can explain the observation of coinfected cases. Indeed there is strong resemblance in symptoms between these diseases making problematic targeted medical care of coinfected cases. This is due to the fact that the origin of illness is not obviously known. Some cases could be immunized against one or the other of the pathogens, immunity typically acquired with factors like age and exposure as usual for endemic area. Then, coinfection needs to be better diagnosed. Using data collected from patients in Kedougou region, from 2009 to 2013, we adjusted a multinomial logistic model and selected relevant variables in explaining coinfection status. We observed specific sets of variables explaining each of the diseases exclusively and the coinfection. We tested the independence between arboviral and malaria infections and derived coinfection probabilities from the model fitting. In case of a coinfection probability greater than a threshold value to be calibrated on the data, duration of illness above 3 days and age above 10 years-old are mostly indicative of arboviral disease while body temperature higher than 40{\textdegree}C and presence of nausea or vomiting symptoms during the rainy season are mostly indicative of malaria disease.