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The majority of fevers in African children are not caused by malaria


In 2007, an estimated 656 million fevers occurred in African children aged 0-4 years, with 78 million children of the 183 million attending a public health care facility likely to have been infected with P. falciparum (range 60-103 million), the parasite that causes the most dangerous form of malaria. These findings come from a modelling system devised by Peter Gething and colleagues from the Malaria Atlas Project, a multinational team of researchers funded mainly by the Wellcome Trust.

These findings, published in PLoS Medicine, are important given international efforts to increase the coverage of artemisinin-based combination therapy (ACT) in public health sectors and the mounting concern that the continued indiscriminate presumptive use of ACT for treating all childhood fevers may lead to resistance to one of the main drug classes currently effective in the treatment of falciparum malaria.

The authors were able to quantify the number of children with fevers who do and do not have malaria by gathering data on paediatric fever prevalence, treatment-seeking rates, and childhood populations and combining this information with a geographical information system model. The authors then assembled data to estimate plausible ranges for the proportion of paediatric fevers seen at clinics positive for P. falciparum in different malaria endemic areas.

This study provides a useful map of the prevalence of malarial and non-malarial childhood fevers across sub-Saharan Africa and an indication of how many of the children with fever reaching public clinics are likely to have malaria and might therefore benefit from ACT. Furthermore, these findings also highlight the potential benefits of introducing rapid diagnostic testing for malaria and can now be used to quantify the resources needed for and the potential clinical benefits of different policies for the introduction of rapid diagnostic testing for malaria across Africa.


Funding: PWG is supported by the Wellcome Trust Senior Research Fellowship held by Dr Simon Hay at the University of Oxford, UK (#079091). EAO is supported by the Wellcome Trust as a Research Training Fellow (#086166). AMN is supported by the Wellcome Trust as a Research Training Fellow (#081829).RWS is supported by the Wellcome Trust as Principal Research Fellow (#079080). This work forms part of the output of the Malaria Atlas Project (MAP,, which is principally funded by the Wellcome Trust, UK. RWS and AMN also acknowledge support from the Kenya Medical Research Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: RWS chaired Novartis's National Malaria Control Programme Best Practice Workshops for several years in Africa for which he was paid an honorarium. The need for defining drug commodity requirements by countries stems from these workshops. RWS thanks Novartis and the national programme participants of these workshops. Novartis has not, however, influenced the design of the data assembly, analysis, or interpretation of the results presented in this paper.

Citation: Gething PW, Kirui VC, Alegana VA, Okiro EA, Noor AM, et al. (2010) Estimating the Number of Paediatric Fevers Associated with Malaria Infection Presenting to Africa's Public Health Sector in 2007. PLoS Med 7(7): e1000301. doi:10.1371/journal.pmed.1000301




Dr. Peter Gething
University of Oxford
Department of Zoology
Tinbergen Building
South Parks Road
Oxford, Oxfordshire OX1 3PS
United Kingdom
+44 (0)1865 271262

Notes for editors

1. The Malaria Atlas Project (MAP) is funded by The Wellcome Trust (UK) to assemble medical intelligence and survey data to provide evidence-based maps on the distribution of malaria risk, human population, disease burdens, mosquito vectors, inherited blood disorders and malaria financing and control worldwide. The maps generated are the results of a collaboration between malaria scientists in the UK, Kenya, Vietnam, Indonesia, Ecuador and the USA. MAP work in the Asia-Pacific region has been additionally supported by a grant from the Li Ka Shing Foundation. For further information visit

2. The Wellcome Trust is a global charity dedicated to achieving extraordinary improvements in human and animal health. It supports the brightest minds in biomedical research and the medical humanities. The Trust's breadth of support includes public engagement, education and the application of research to improve health. It is independent of both political and commercial interests.

3. The Department of Zoology, within the Mathematical, Physical and Life Sciences Division at the University of Oxford, has a long-standing reputation for world class research and teaching. Research in the Department is organised into several research themes; these span a broad spectrum of biology ranging from ecology and behaviour, through to molecular evolution, development and infectious disease biology.

4. The Kenya Medical Research Institute (KEMRI) is a Kenya government parastatal with the responsibility for health research to improve the health of Kenyans. It is one of the most well developed national research institutes in Africa with a network of centres across Kenya such as the Centre of Geographic Medicine Research Coast (CGMR-C) that is home to the KEMRI-Wellcome Trust Research Programme. The programme formally established in 1989, is a partnership between KEMRI, Oxford University and the Wellcome Trust. It conducts basic, epidemiological and clinical research in parallel, with results feeding directly into local and international health policy, and aims to expand the country's capacity to conduct multidisciplinary research that is strong, sustainable and internationally competitive.

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