Abstract
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. We present 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.
Highlights
Following new case management guidelines issued by the World Health Organization in 2010, individuals presenting with fever at a health clinic in sub-Saharan Africa have an increased chance of receiving a rapid diagnostic test (RDT) prior to receiving antimalarial treatment (World Health Organization, 2015)
All-cause fever prevalence was calculated as the sum of the two metrics estimated by the model: prevalence of P. falciparum malaria-attributable fever (MAF) and non-malarial febrile illness (NMFI)
The analysis presented here shows that the proportion of fever cases that are accompanied by an RDT-patent P. falciparum infection remains high, only approximately a third of these fevers are causally attributable to malaria
Summary
Following new case management guidelines issued by the World Health Organization in 2010, individuals presenting with fever at a health clinic in sub-Saharan Africa have an increased chance of receiving a rapid diagnostic test (RDT) prior to receiving antimalarial treatment (World Health Organization, 2015). This reduces the over-prescription of antimalarial drugs to uninfected patients while ensuring patent infections are identified and the parasites cleared through treatment. Fevers caused by another pathogen but coincident with a malaria infection will suffer a systematic under-reporting under this protocol and the disease burden of non-malarial febrile illness (NMFI) will be underestimated.
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