Relying solely on test kits for fever diagnosis in children may be inadequate — Don

WHILE malaria is often assumed to be the main cause of fevers, relying solely on malaria rapid diagnostic tests in children can lead to misdiagnosis and inappropriate treatment for other infections, a don has warned.

Professor Adebola Orimadegun, in his 2022/23 inaugural lecture at the University of Ibadan (UI), entitled ‘Child Health Dynamics: Chances, Choices, and Consequences,’ said febrile illnesses are a significant cause of illness and death in children under five, particularly in low and middle-income countries.

As such, identifying the underlying causes is crucial for accurate diagnosis and treatment.

Orimadegun, the director of the Institute of Child Health at the university, said an over-reliance on malaria rapid diagnostic tests (mRDTs) can also lead to the omission of other serious febrile disorders, which can result in incorrect therapy, increased morbidity and the possibility of drug resistance.

According to him, a 2022 study conducted in southwestern Nigeria examined non-malarial fevers in children under five who had negative mRDTs in both rural and urban areas and revealed that a sizable percentage (37.2 percent) of these children’s fevers were non-malarial, suggesting a high prevalence of other febrile illnesses.

According to him, viral infections (54.7 percent) and bacterial infections (32.1 percent) were the most common non-malarial disease-causing germs, including urinary tract infections, skin infections and middle ear infections.

“By expanding our diagnostic approach beyond malaria, we can improve the accuracy of diagnoses and appropriate treatments for fevers in children, leading to better health outcomes and reduced drug resistance,” the don said.

Professor Orimadegun said it is important that healthcare professionals consider a wider range of diagnoses beyond malaria in febrile children, even as he mentioned the study’s call for a more comprehensive diagnostic approach for febrile illness, improved surveillance systems and diagnostic capabilities to effectively identify and treat non-malarial febrile illnesses.

He also warned against restricting malaria treatment to children that tested positive for malaria with the mRDTs because of the possibility of a re-infection after 28 days of treatment, even by children with negative malaria results based on mRDTs.

He highlighted the need for improved diagnostic methods because microscopy and rapid diagnostic tests underestimated the prevalence of asymptomatic malaria compared to PCR, given that asymptomatic carriers serve as reservoirs for malaria transmission, complicating control efforts.

Professor Orimadegun, however, made case for the need for a holistic approach that considers biological, environmental, and social determinants of child health, while calling for evidence-based strategies to address health disparities and ensure that every child has the opportunity to make healthy choices.

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