The Changing Face of Fever in Tanzanian Children

Summary and Comment |
February 26, 2014

The Changing Face of Fever in Tanzanian Children

  1. Larry M. Baddour, MD

The majority of infections were caused by viruses.

  1. Larry M. Baddour, MD

The etiology of nonmalarial fever is becoming more important in malaria-endemic areas where incidence of that disease is decreasing. Improved understanding is needed to optimize care and decrease inappropriate antibiotic use.

To determine the causes of nonmalarial fever, researchers conducted a prospective survey of consecutive children aged 2 months to 10 years presenting with an axillary temperature of ≥38°C at one of two outpatient clinics in Tanzania in 2008. One clinic was rural and one was urban; both were in areas of low malarial endemicity. The researchers used standardized procedures to obtain medical histories and perform clinical examinations; they also collected blood and nasopharyngeal specimens for laboratory testing.

Overall, 1232 diagnoses were established in 1005 children; multiple conditions were diagnosed in 227 (22.6%). The proportions of children with viral, bacterial, and parasitic diseases were 70.5%, 22.0%, and 10.9%, respectively. At both clinics, fever was the main complaint in most of the children. Acute respiratory infection was seen in 62.2%, and malaria in only 10.4%. No infectious cause of fever could be found in 3.2% of the children.


At least two factors have emerged in recent years that have affected fever management in malaria-endemic areas. First, the incidence of malaria has decreased in some regions due to enhanced preventive measures. Second, new laboratory diagnostic tools that provide rapid results to identify colonizing or infecting pathogens have become available. These changes have prompted a reevaluation of the wholesale use of antimalarial and antimicrobial therapies, with an effort to be more selective in their administration — as is espoused in an accompanying editorial.

Editor Disclosures at Time of Publication

  • Disclosures for Larry M. Baddour, MD at time of publication Editorial boards UpToDate Leadership positions in professional societies American Heart Association (Chairman, Rheumatic Fever, Endocarditis, Kawasaki Disease Committee)


Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.