Although the prevalence of fever amongst African children is around 30%, only 10% of these fevers (and 28% of malaria-positive fevers) are actually directly attributable to malaria infection due to the high prevalence of non-malarial febrile illnesses.
Suspected malaria cases in Africa increasingly receive a rapid diagnostic test (RDT) before antimalarials are prescribed. While this ensures efficient use of resources to clear parasites, the underlying cause of the individual’s fever remains unknown due to potential coinfection with a non-malarial febrile illness. Widespread use of RDTs does not necessarily prevent over-estimation of clinical malaria cases or sub-optimal case management of febrile patients. In a recent publication in the journal eLife, we presented a new approach that allows inference of the spatiotemporal prevalence of both Plasmodium falciparum malaria-attributable and non-malarial fever in sub-Saharan African children from 2006 to 2014. We estimate that 35.7% of all self-reported fevers were accompanied by a malaria infection in 2014, but that only 28.0% of those (10.0% of all fevers) were causally attributable to malaria. Most fevers among malaria-positive children are therefore caused by non-malaria illnesses. This refined understanding can help improve interpretation of the burden of febrile illness and shape policy on fever case management.
Quantifying the contribution of Plasmodium falciparum malaria to febrile illness amongst African children. Ursula Dalrymple, Ewan Cameron, Samir Bhatt, Daniel J Weiss, Sunetra Gupta, Peter W Gething. eLife, 2017; 6: e29198