Non-malarial febrile illness

The need for better tests and diagnostic strategies

Acute fever in the tropics and sub-tropics has often been considered to be primarily due to malaria, and treated as such. As accurate diagnosis for malaria, based on microscopy and rapid diagnostic tests, is introduced across malaria-endemic regions, it is becoming increasingly apparent that most fevers are due to other causes (i.e. non-malarial febrile illness, NMFI), particularly in areas where anti-malarial interventions are well implemented. The malaria test is negative, but the patient is still sick.

The consequences from febrile disease can hold communities back from becoming self-supporting. The cost of severe illness and high transmission of infectious disease in terms of money spent on health care, loss of the family bread-winner due to illness, a reduction in income through time off work, and the human cost of a death in the family are difficult to measure. Communities need the capacity to manage these severe but treatable and preventable impacts on the lives of their members.

Our approach

To address NMFI or acute fever as a syndrome we:

  • consider that a sick person with acute fever may have malaria (treatable, must be detected quickly); one of a number of other potentially severe infections (mostly treatable, must be detected quickly; NMFI); other mild and self-limiting infection(s), such as viral respiratory tract infection;
  • recognize that resources, both financial and human, are limited in our target countries and concentrate on diagnostic interventions that provide the highest return;
  • allow more effective use of existing drugs;
  • ensure tests/strategies are appropriate for the skills and workplace of clinicians/health workers;
  • minimize the need for additional logistical and other resource requirements for health services;
  • concentrate on platforms and tests that are compatible with existing tools (e.g. malaria tests);
  • concentrate on tests/strategies that are sustainable within a national health programme, minimizing need for long-term external support.