Malaria Coinfections Worldwide: An Umbrella Systematic Review of Prevalence and Epidemiological Patterns

Malaria coinfections with other infectious agents represent a clinically relevant epidemiological challenge, but evidence remains fragmented across individual systematic reviews. This umbrella systematic review synthesized review-level evidence on the prevalence and epidemiological patterns of concurrent malaria coinfections in human populations. PubMed/MEDLINE, Scopus, Web of Science, Embase, and LILACS/BVS were searched for systematic reviews published from 1 January 2000 to March 2026. Risk of bias, certainty of evidence, and primary-study overlap were assessed using ROBIS, an adapted GRADE framework for prevalence evidence, and citation-matrix/corrected-covered-area methods, respectively. Twenty-one systematic reviews were included, of which 16 contributed meta-analytical prevalence estimates. Among acute-pattern coinfections, review-level prevalence estimates ranged from 3.0% (95% CI: 2.0-5.0) for malaria-influenza to 21.7% (95% CI: 18.7-25.1) for malaria-Ebola virus disease. Among chronic or persistent-pattern coinfections, estimates ranged from 6.0% (95% CI: 4.0-7.0) for malaria-hepatitis B to 50.0% (95% CI: 28.0-72.0) for malaria-human African trypanosomiasis; the latter reflects Plasmodium positivity among patients with human African trypanosomiasis and should not be interpreted as a population-level prevalence. Sub-Saharan Africa was the most represented region. Certainty of evidence was generally low or very low, largely because of substantial heterogeneity, diagnostic variability, geographic concentration, and overlap among some source reviews. Malaria coinfections are clinically and epidemiologically relevant in endemic settings, but available prevalence estimates should be interpreted as context-dependent review-level summaries rather than globally comparable burden estimates.