Severe malaria in Cameroon: a systematic review of a sticky problem and associated challenges to guide public health strategies in Africa

• A systematic review on severe malaria (SM) in Cameroon was undertaken. • SM is the main reason for clinical hospitalisation, with rates of ∼9.09% – 66.3%. • Neurological disorders are predominant (e.g., cerebral malaria – 2.7% - 100%). • Atypical signs (e.g., abundant epistaxis) are also seen in SM cases. • Essential to decipher the role of bacteria, Epstein-Barr virus, or the microbiome. Severe malaria (SM) is a possible outcome of infection with Plasmodium spp . parasites. Cameroon, a malaria endemic country, has made enormous progress in the control of malaria over the last two decades; however, some points, such as SM, need to be better understood. This systematic review presents a comprehensive and critical view of the existing Cameroonian literature on SM over the last 40 years, with the final objective to identify major challenges for Africa. Relevant databases (PubMed, Ovid, Scopus, Cochrane Library, and ClinicalTrials.gov) were queried to identify potentially eligible studies. The review identified 52 relevant studies. SM, only due to Plasmodium falciparum , is the main reason for hospitalisation, at varying rates (∼9.09% – 66.3%). Neurological disorders (i.e., cerebral malaria – 2.7% - 100%, convulsions – 24.6% - 91.7%, prostration – 5.5% - 61.9%, and impaired consciousness – 15.9% - 56.3%) are the predominant SM signs, followed by other signs such as hyperpyrexia (∼36% – 68.2%) and severe malarial anaemia (∼14.9% – 64.8%). Atypical signs, including severe thrombocytopenia and abundant epistaxis, are also seen in SM. Addressing SM is a crucial step in tackling malaria, but some unexplored knowledge gaps, such as the clinical impact of concurrent bacterial infections, Epstein-Barr virus, pfhrp2 deletions, malnutrition, and the gut microbiome, should be addressed.