Quantifying the contribution of Plasmodium falciparum malaria to febrile illness amongst African children

Abstract

Suspected malaria cases in Africa increasingly receive a rapid diagnostic test (RDT) before antimalarials are prescribed. While this ensures efficient use of resources to clear parasites, the underlying cause of the individual's fever remains unknown due to potential coinfection with a non-malarial febrile illness. Widespread use of RDTs does not necessarily prevent over-estimation of clinical malaria cases or sub-optimal case management of febrile patients. We present a new approach that allows inference of the spatiotemporal prevalence of both Plasmodium falciparum malaria-attributable and non-malarial fever in sub-Saharan African children from 2006-2014. We estimate that 35.7% of all self-reported fevers were accompanied by a malaria infection in 2014, but that only 28.0% of those (10.0% of all fevers) were causally attributable to malaria. Most fevers among malaria-positive children are therefore caused by non-malaria illnesses. This refined understanding can help improve interpretation of the burden of febrile illness and shape policy on fever case management.

Data availability

The following previously published data sets were used
    1. DHS Program
    (2006) DHS Program Datasets
    Available upon request from the DHS Program.

Article and author information

Author details

  1. Ursula Dalrymple

    Department of Zoology, University of Oxford, Oxford, United Kingdom
    For correspondence
    ursula.dalrymple@zoo.ox.ac.uk
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-6206-3777
  2. Ewan Cameron

    Big Data Institute, University of Oxford, Oxford, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.
  3. Samir Bhatt

    Big Data Institute, University of Oxford, Oxford, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.
  4. Daniel J Weiss

    Big Data Institute, University of Oxford, Oxford, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.
  5. Sunetra Gupta

    Department of Zoology, University of Oxford, Oxford, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.
  6. Peter W Gething

    Big Data Institute, University of Oxford, Oxford, United Kingdom
    For correspondence
    peter.gething@bdi.ox.ac.uk
    Competing interests
    The authors declare that no competing interests exist.

Funding

Medical Research Council (Doctoral Training Grant)

  • Ursula Dalrymple

Bill and Melinda Gates Foundation (H5R00640 H5R00690)

  • Ewan Cameron
  • Samir Bhatt
  • Daniel J Weiss
  • Peter W Gething

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Reviewing Editor

  1. Mark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom

Version history

  1. Received: June 1, 2017
  2. Accepted: October 12, 2017
  3. Accepted Manuscript published: October 16, 2017 (version 1)
  4. Version of Record published: November 1, 2017 (version 2)
  5. Version of Record updated: May 16, 2018 (version 3)

Copyright

© 2017, Dalrymple et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Ursula Dalrymple
  2. Ewan Cameron
  3. Samir Bhatt
  4. Daniel J Weiss
  5. Sunetra Gupta
  6. Peter W Gething
(2017)
Quantifying the contribution of Plasmodium falciparum malaria to febrile illness amongst African children
eLife 6:e29198.
https://doi.org/10.7554/eLife.29198

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https://doi.org/10.7554/eLife.29198

Further reading

    1. Epidemiology and Global Health
    Caroline Krag, Maria Saur Svane ... Tinne Laurberg
    Research Article

    Background:

    Comorbidity with type 2 diabetes (T2D) results in worsening of cancer-specific and overall prognosis in colorectal cancer (CRC) patients. The treatment of CRC per se may be diabetogenic. We assessed the impact of different types of surgical cancer resections and oncological treatment on risk of T2D development in CRC patients.

    Methods:

    We developed a population-based cohort study including all Danish CRC patients, who had undergone CRC surgery between 2001 and 2018. Using nationwide register data, we identified and followed patients from date of surgery and until new onset of T2D, death, or end of follow-up.

    Results:

    In total, 46,373 CRC patients were included and divided into six groups according to type of surgical resection: 10,566 Right-No-Chemo (23%), 4645 Right-Chemo (10%), 10,151 Left-No-Chemo (22%), 5257 Left-Chemo (11%), 9618 Rectal-No-Chemo (21%), and 6136 Rectal-Chemo (13%). During 245,466 person-years of follow-up, 2556 patients developed T2D. The incidence rate (IR) of T2D was highest in the Left-Chemo group 11.3 (95% CI: 10.4–12.2) per 1000 person-years and lowest in the Rectal-No-Chemo group 9.6 (95% CI: 8.8–10.4). Between-group unadjusted hazard ratio (HR) of developing T2D was similar and non-significant. In the adjusted analysis, Rectal-No-Chemo was associated with lower T2D risk (HR 0.86 [95% CI 0.75–0.98]) compared to Right-No-Chemo.

    For all six groups, an increased level of body mass index (BMI) resulted in a nearly twofold increased risk of developing T2D.

    Conclusions:

    This study suggests that postoperative T2D screening should be prioritised in CRC survivors with overweight/obesity regardless of type of CRC treatment applied.

    Funding:

    The Novo Nordisk Foundation (NNF17SA0031406); TrygFonden (101390; 20045; 125132).