Feeling feverish does not mean you have malaria

Apr 01, 2017

There are many causes of fever, both infectious and noninfectious.

By Dr Daniel Tumwine

There was a time, a few decades ago at the height of the malaria scourge, that professors taught their students: ‘In Uganda, a person with a fever has malaria until proven otherwise.'

This mantra was drummed into us from the early days of our training, so much that it was the norm for a person walking into a health centre to first receive anti-malaria medication and diagnosis would come later.

So common were malaria deaths and illnesses that more than half of all patients in any given hospital had malaria.

Things are different today.

Of the two years our children's clinic has been open, we have confirmed only six cases of malaria. Five of these were ‘import cases' meaning that the children had arrived from outside Kampala before they fell ill.

Indeed, in Kampala, malaria remains rare.

The Ministry of Health estimates that 0.4% of Kampala children have a positive microscopic diagnosis of malaria. Things are different outside Kampala, where nearly half (48%) of children in Karamoja are positive for malaria parasites.

However, because of the institution of many malaria control measures such as the provision of long-lasting insecticide-treated nets; prompt testing before treatment; indoor residual spraying as well as; effective and correct treatment, the prevalence of malaria in young children in Uganda has dropped from 52% in 2009 to 30% today.

Despite only 0.4% of Kampala children having proven malaria, 51.5% of all Kampala children with fevers still receive malaria medication.

So engrained is the culture of assuming any fever is malaria that even the Luganda word for fever omussujja is taken to mean malaria.

As a consequence, a Kampala parent nursing a child with fever will rush to the drug store to buy anti-malaria medication.

When your child has a fever

There are many causes of fever, both infectious and noninfectious.

Commonly, a person with a fever might be fighting an infection. It could be bacteria such as ‘Streptococcus Pneumoniae' which causes sore throat or pneumonia, or it could be a virus such as ‘Rota virus' which causes diarrhoea and vomiting.

This is why it is important to do tests that include the distribution of the white blood cells. How the white blood cells react can give a clue as to whether an infection is present or not and the type of infection causing the illness.

Many times health workers test for brucellosis, typhoid and other bacteria if the source of the fever is not found.

These conditions usually have very specific c presentations that accompany them. For example, typhoid commonly presents with abdominal pain, headache, diarrhoea or constipation as well as body aches.

Left untreated, the fever of typhoid usually climbs extremely high.

Commonly used laboratory diagnostic test for typhoid -The Widal Test, is extremely non-specific if used only once, meaning even if you do not have typhoid, it may show as if you do.

This test, commonly used in Kampala health centres, has been rendered obsolete and discarded in many countries.

Commonly, a child with fevers, joint pain and joint swelling could be having juvenile arthritis or other autoimmune conditions such as Systemic Lupus Erythematosus or Vasculitis.

Autoimmune conditions have been found to be more common than previously thought, but are rarely looked out for by health workers. They are conditions where the body attacks itself, thinking some parts of it are foreign.

Most cancers will present with a fever, however, they usually present with other symptoms. For example, cancers of the blood, which are common among young children, also present with signs and symptoms of anaemia such as being tired all the time.

They may also present with bleeding.

Tuberculosis (TB) is also a relatively common cause of fever. TB can occur anywhere in the body. Not just in the lungs.

A common cause of fever that is often overlooked is drugs. Many drugs can cause fever and stopping them can lead to resolution of this fever.

Even though all drugs have the potential to cause fever, some anti-cancer medication, antiretroviral (ARVs) drugs, and some antibiotics such as ceftriaxone and drugs in its group, are notorious for causing fever.

In conclusion, fever is caused by many things other than malaria. It is important that when one has a fever, effort is made to actually identify the cause of the fever and treat the correct culprit.

The writer is a paediatrician at The Children's Clinic in Kansanga and the executive director of the Uganda Paediatrics Association outside Kampala before they fell ill.

The writer is a paediatrician at The Children's Clinic in Kansanga and the executive director of the Uganda Paediatrics Association.

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