Abstract
Fever means a body temperature that is above normal. It is the most common symptom people seeking health care present with at health facilities. There are many etiologies of fever but the most common is infection (viral, bacterial, fungal or protozoan) and malaria is the most commonly incriminated in tropical countries including Nigeria. This is due to the endemicity of the disease in these regions, yet ‘endemicity’ is not synonymous with ‘will have malaria’. Malaria keep being over diagnosed in fever cases in these regions while other etiologies of fever are being overlooked and un-investigated resulting in poor patient outcome amongst other public health issues such as antimalarial resistance and patient mismanagement. Other non-malaria infectious diseases commonly misdiagnosed as malaria include bacterial sepsis, arbovirus infection, otitis media in children and so on. Studies have revealed that a lot of febrile patients are being misdiagnosed as having malaria and are being treated with an antimalarial drug they do not need. Factors responsible for this misdiagnosis include lack of awareness/bias, lack of fever management policy, human resource for health challenge and outdated/cumbersome diagnostic tools. Consequences of misdiagnosis include resistance to expensively researched antimalarial drugs, economic loss, prolonged suffering of patient, risk of death and risk of epidemic outbreak. The way out includes awareness that all fever cases are not malaria, implementation of fever management policy, research to establish other etiologies of fever in Nigeria other than malaria, testing for other etiologies of fever alongside malaria and use of better diagnostic tools for fever diagnosis.
Highlights
Fever is the most common complaints people seeking healthcare present with in low-income, middle-income and developing countries like Nigeria [1,2]
This study revealed that malaria is uncommon and over diagnosed while invasive infections such as bacterial zoonoses and arbovirus infections though highly prevalent were overlooked [7]
In another study carried out by [10] in Borno state, of 310 fever cases studied, less than 1% were positive for malaria only, 3.7% tested positive for typhoid only, while in addition to malaria, 76.8% cases tested positive for more than one arbovirus infection and about 48% tested positive for malaria and a single arbovirus infection
Summary
Fever is the most common complaints people seeking healthcare present with in low-income, middle-income and developing countries like Nigeria [1,2]. A great proportion of infectious diseases have fever as one of their clinical symptoms, this makes the diagnosis of febrile illnesses technical. The study involved 1,193 febrile patients, and only about 47% had malaria (P. falciparum and P. vivax) as the cause of their fever (using highly sensitive malaria diagnosis methods- molecular inclusive). Deeper and more thorough diagnostic screening and procedures revealed that bacterial, mycobacterial and fungal bloodstream infections accounted for 85 (9.8%) of the 540, 14 (1.6%) of the 540 and 25 (2.9%) of the 540 was the actual cause of fever respectively. This study revealed that malaria (in contrast to the initial diagnosis and reason for admission) is uncommon and over diagnosed while invasive infections such as bacterial zoonoses and arbovirus infections though highly prevalent were overlooked [7]
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