COVID-19 exhibits similarities in clinical presentation (fever, difficulty in breathing, fatigue, and headaches) and empirical treatment with malaria. Also, they share some pathophysiological characteristics, which supports the overlap in clinical presentations. It is postulated that COVID-19-related interference will lead to a significant increase in malaria-related morbidity. Since malaria is believed to alter the clinical picture of COVID-19 in developing countries, it is essential to investigate this interaction further and use the outcome to guide the diagnosis, treatment, and control of malaria and COVID 19 globally. Our proposed study will also attempt to unravel the relatively low fatality from COVID 19 in Africa. We will investigate the influence of the human angiotensin-converting enzyme II (ACE 2) Genotype and Glucose-6-phosphate dehydrogenase (G6PD) deficiency to COVID 19 susceptibility. The high frequency of the ACE II gene deletion among African ethnic groups with asymptomatic submicroscopic malarial infections could help resolve the link between malaria and COVID-19 susceptibility. Both G6PD deficiency and SARS-CoV-2 compromise the antioxidant system through the same pathways, indicating that the evolutionary antimalarial advantage of G6PD deficient persons can be a disadvantage in SARS-CoV-2 infection.

There has been a significant increase in the availability and accessibility of commercially available RDTs that target Plasmodium falciparum histidine-rich protein (PfHRP2). In recent times, concern surrounding the reduction in the performance of these RDTs in some endemic areas has been reported, and this has been linked to the antigenic variability of the target protein, the persistence of antigen in the blood after parasite killing, parasite density below the detection threshold and the spread of parasites with pfhrp2 and or pfhrp3 deleted genes. This study investigates the scope and scale of the pfhrp2/3-deleted parasite and its implications for accurate RDT diagnosis in Nigeria. The overarching aim of this research project is to study the prevalence, genetic diversity, and gene deletions of pfhrp2/3 genes of P. falciparum collected from a large, nationally representative cross-sectional study of symptomatic and asymptomatic children, pregnant women, and adults; and its implication on the performance of PfHRP2-based RDT in Nigeria.