title: Is Plasmodium vivax malaria a severe malaria?: a systematic review and meta-analysis.
abstract: BACKGROUND
  Plasmodium vivax is one of the major species of malaria infecting humans. Although emphasis on P. falciparum is appropriate, the burden of vivax malaria should be given due attention. This study aimed to synthesize the evidence on severe malaria in P. vivax infection compared with that in P. falciparum infection.
  
  
  RESULTS
  We searched relevant studies in electronic databases. The main outcomes required for inclusion in the review were mortality, severe malaria (SM) and severe anaemia (SA). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Overall, 26 studies were included. The main meta-analysis was restricted to the high quality studies. Eight studies (n = 27490) compared the incidence of SM between P. vivax infection and P. falciparum mono-infection; a comparable incidence was found in infants (OR: 0.45, 95% CI:0.04-5.68, I2:98%), under 5 year age group (OR: 2.06, 95% CI: 0.83-5.1, I2:83%), the 5-15 year-age group (OR: 0.6, 95% CI: 0.31-1.16, I2:81%) and adults (OR: 0.83, 95% CI: 0.67-1.03, I2:25%). Six studies reported the incidences of SA in P. vivax infection and P. falciparum mono-infection; a comparable incidence of SA was found among infants (OR: 3.47, 95%:0.64-18.94, I2: 92%), the 5-15 year-age group (OR:0.71, 95% CI: 0.06-8.57, I2:82%). This was significantly lower in adults (OR:0.75, 95% CI: 0.62-0.92, I2:0%). Five studies (n = 71079) compared the mortality rate between vivax malaria and falciparum malaria. A lower rate of mortality was found in infants with vivax malaria (OR:0.61, 95% CI:0.5-0.76, I2:0%), while this was comparable in the 5-15 year- age group (OR: 0.43, 95% CI:0.06-2.91, I2:84%) and the children of unspecified-age group (OR: 0.77, 95% CI:0.59-1.01, I2:0%).
  
  
  CONCLUSIONS
  Overall, the present analysis identified that the incidence of SM in patients infected with P. vivax was considerable, indicating that P. vivax is a major cause of SM. Awareness of the clinical manifestations of vivax malaria should prompt early detection. Subsequent treatment and monitoring of complications can be life-saving.
authors.affiliation: School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Cho
authors.initials: C
authors.lastname: Naing
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Maxine A
authors.initials: MA
authors.lastname: Whittaker
authors.affiliation: School of Medicine, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Victor
authors.initials: V
authors.lastname: Nyunt Wai
authors.affiliation: School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Joon Wah
authors.initials: JW
authors.lastname: Mak
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D004351:Drug Resistance; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000453:epidemiology; D016780:Malaria, Vivax / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000453:epidemiology
chemical_list: D002738:Chloroquine