Comparative Prevalence and Risk Factors Assessment of Typhoid and Malaria Fevers Among Febrile Patients In Akure, Nigeria

Background: Acute febrile illness remains a major diagnostic challenge in malaria-endemic regions because malaria and bacterial bloodstream infections may present with overlapping clinical manifestations. This study therefore investigated malaria–Salmonella co-infection among febrile patients attending selected hospitals in Akure, Ondo State, Nigeria, and also assessed the associated risk factors. The antibiogram profile of the isolated Salmonella isolates was also studied. Methods: A descriptive cross-sectional study was conducted among 444 febrile patients attending selected healthcare facilities in Akure who consented to the study. Sociodemographic and environmental information was obtained using a well-structured questionnaire. Malarial infection was assessed by examination of blood films for malarial parasites. Typhoid infection was initially assessed serologically using the Widal agglutination test, while blood culture and biochemical characterisation were used for the confirmation and identification of Salmonella isolates. Antibiotic susceptibility testing was performed on the isolated Salmonella species against common antibiotics. Descriptive statistics and chi-square tests were used for the analysis of the data obtained. Results: Malarial parasites were detected in 385 of 444 febrile patients (86.7%) tested. Widal testing was positive in 109 patients (24.5%); however, blood culture confirmed typhoid infection in only 39 patients (8.8%). Thirty-seven patients (8.3%) had concurrent malaria and culture-confirmed typhoid infection. Among the 39 Salmonella isolates, the most frequently encountered species was Salmonella typhi (18/39; 46.2%), followed by S. paratyphi B (11/39; 28.2%), S. paratyphi C (6/39; 15.4%) and the least was S. paratyphi A (4/39; 10.3%). Age and gender were not significantly associated with infection distribution (p ≥ 0.05). The isolated Salmonella spp. were susceptible to azithromycin (89.7%) and cefotaxime (87.2%) but had reduced susceptibility to fluoroquinolones. Conclusion: The study demonstrates a high burden of malaria but low confirmed cases of typhoid fever and Malaria-typhoid co-infection among febrile patients in Akure. The discrepancy between Widal test positivity and culture-confirmed Salmonella infection highlights the importance of bacteriological confirmation before diagnosis of typhoid fever. Reduced fluoroquinolone susceptibility emphasises the need for continued antibiotic susceptibility surveillance.