Understanding Acute Febrile Syndrome (AFS)

Acute febrile disease in the tropics and sub-tropics has often been considered to be due to malaria and treated as such. As accurate diagnosis for malaria, based on rapid diagnostic tests, is rolled out across malaria-endemic regions, it is becoming increasingly apparent that most fevers are due to other causes. By ‘acute febrile syndrome’ in this context we mean causes of acute (sudden) fever and related symptoms that are similar to malaria. These are usually due to infection, resulting from a wide variety of pathogens.

While many sources of fever, particularly viruses, cause only temporary and self-limiting illness, some are severe and overall cause greater mortality than malaria. Most of these severe diseases are readily curable if diagnosed and treated early. As with malaria, early accurate identification and appropriate treatment is key to reduction in morbidity and mortality.

Addressing AFS in a holistic manner will require a strategic mix of new knowledge on prevalence and impact of disease, development of new tools, sustainable management algorithms and the infrastructure to support them. These are system-wide issues, providing challenges but also huge opportunities for improvement in healthcare delivery. Emerging technologies in diagnostics raise the potential to address fundamental deficiencies in health services and opportunity in low-resource countries.

Our focus therefore addresses acute management of fever, combining the need to improve malaria diagnosis with the need to address the alternative causes of fever, and what to do when the malaria test result is negative. Ultimately, good diagnosis will reduce childhood and adult mortality, enable other interventions to achieve their potential, and ultimately provide the information necessary to eliminate a range of diseases.