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Despite their frequent geographical overlap, the potential epidemiological patterns and potential interactions associated with\n                      <jats:italic>Plasmodium<\/jats:italic>\n                      \u2013-\n                      <jats:italic>Schistosoma<\/jats:italic>\n                      co-infection remain poorly characterized. This study aimed to systematically assess the epidemiology of malaria\u2013schistosomiasis co-infection and to quantify whether co-infections occur more frequently than expected under an assumption of independence between the two infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review and meta-analysis in accordance with the PRISMA 2020 guidelines. A total of 192 studies published between 1996 and 2023 were included in the qualitative synthesis, of which 59 studies involving 73,383 individuals were included in the meta-analysis. Pooled odds ratio (\n                      <jats:italic>ORs<\/jats:italic>\n                      ) were estimated to compare observed and expected co-infection prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The pooled analysis showed that\n                      <jats:italic>Plasmodium-Schistosoma<\/jats:italic>\n                      co-infection occurs more frequently than expected by chance (overall\n                      <jats:italic>OR<\/jats:italic>\n                      = 1.20, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      1.02\u20131.40), despite substantial heterogeneity across studies (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>\n                        <jats:italic>2<\/jats:italic>\n                      <\/jats:sup>\n                      = 89%). Reported co-infection prevalence ranged from 1.1% in Benin to 36.6% in Mali. School-age children and pregnant women were disproportionately affected. Subgroup analyses revealed no consistent differences according to sex or parasite species.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings indicate a non-random distribution of malaria-schistosomiasis co-infection in sub-Saharan Africa, consistent with epidemiological over-dispersion. Although the underlying biological and immunological mechanisms remain uncertain, the widespread co-occurrence of these parasites highlights the importance of integrated surveillance and control strategies that account for polyparasitism in endemic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-026-01490-1","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:48:12Z","timestamp":1791528492000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Over-dispersion in malaria\u2013schistosoma co-infection: insights from a meta-analytical approach and systematic review"],"prefix":"10.1186","volume":"15","author":[{"given":"C\u00e9lia","family":"Koellsch\u2013Amet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Boissier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1147-0043","authenticated-orcid":false,"given":"Ronaldo","family":"Augusto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"1490_CR1","unstructured":"World schistosomiasis report 2023. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/schistosomiasis. 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