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The relationship between reported fever and Plasmodium falciparum infection in African children

Emelda A Okiro1, Robert W Snow

  • 1Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, 00100 GPO, Nairobi, Kenya. eokiro@nairobi.kemri-wellcome.org

Malaria Journal
|April 20, 2010
PubMed

Insights

Fever history in African children is less predictive of malaria infection due to changing epidemiology. Diagnosis-based treatment is recommended, especially in high-prevalence areas.

Area of Science:

  • Malariology
  • Epidemiology
  • Pediatric Infectious Diseases

Background:

  • Traditionally, fever prompts presumptive malaria treatment in African children.
  • Shifting malaria epidemiology necessitates re-evaluating fever's predictive accuracy.
  • Calls for a transition to diagnosis-based treatment strategies are increasing.

Purpose of the Study:

  • To assess the relationship between reported childhood fever and Plasmodium falciparum infection.
  • To evaluate fever's predictive value across varying malaria endemicities in Africa.
  • To inform changes in malaria treatment strategies.

Main Methods:

  • Analysis of data from six national malaria indicator surveys (2007-2009).
  • Evaluation of children aged 6-59 months with reported fever.
  • Coincidental Plasmodium falciparum infection detected via rapid diagnostic tests.

Main Results:

  • Children with fever were 1.98 times more likely to have P. falciparum infection.
  • A strong linear correlation (R2 = 0.9147) exists between febrile children with infection and overall infection prevalence.
  • In areas with >34-37% childhood infection prevalence, over 50% of fevers may be malaria-associated.

Conclusions:

  • The utility of diagnosis-based malaria treatment depends on infection prevalence in febrile children.
  • A predictable link between community parasite prevalence and infection risk in febrile children was observed.
  • Existing parasite prevalence maps can guide the implementation of diagnostic strategies in Africa.
Abstract

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