Fever Cases Associated with Plasmodium falciparum Malaria Infection among Children Attending a Tertiary Health Facility in Imo State, Nigeria

Background: Malaria is a major cause of fever in endemic countries, although the prevalence of malaria has been declining across Sub-Saharan Africa, the proportion of clinical presentation attributable to febrile illness due to malaria to febrile illnesses have remained high. It is therefore important to determine the proportion of fever cases attributable to malaria.

Methods: A descriptive cross sectional study was conducted among children aged 1-72 months presenting at a tertiary facility in Imo state Nigeria from 1st March, 2014 to 31st October, 2015.

Children between 1-72 months of age with documented fever at presentation or history of fever in the last 24 hours without signs of severe malaria and those without any history of anti-malarial drugs administration were considered eligible. Fever was regarded as axillary temperature of ≥37.5°C. For all subjects (febrile and afebrile), the presence of Plasmodium falciparum was assessed microscopically by a WHO Certified malaria microscopist. Malaria parasite density was grouped as 1-1000, 1001–10000, and >10,000 parasites/µl respectively according to World Health Organization guidelines for grouping malaria parasitamae while data was analysed using SPSS 20.1v.

Results: Overall malaria prevalence of both febrile and afebrile at point of assessment but with history of fever in the last 24 hours was 24.3%. Prevalence by microscopy was 26% among the 289 children who were febrile as at point of examination. There was no significant difference (p>0.05) between malaria prevalence in males as against females.

Age group 49-72 months had the highest prevalence (42.6%), while age groups 25-48 and 1-24 months recorded prevalence of 35.7% and 25%, respectively (P<0.05). About 22.5% of afebrile patients had positive Plasmodium parasitaemia. The Geo-mean (range) of parasitaemia was 1427(8-180,000) parasite/µl while mean body temperature ± SD was 37.0±0.9°C. About 8% of the children had high parasite density.

Conclusion: Plasmodium falciparum although linked with majority of fever is not the cause of fever in all instances. Healthcare providers should make more effort to correctly diagnose non-malaria febrile cases so as to optimize clinical outcomes for the patients and minimize possible over diagnosis and overtreatment of malaria.