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Non-malaria febrile illness (NFMI) from ACT Consortium on Vimeo.

Scientific title: Identifying non-malarial causes of fever in outpatients from malarious areas in different geographic locations: CONFIT and CONFIA studies

What we did we know before this research?
In Africa it’s common practice to overdiagnose malaria, which means that very often patients are given ACT drugs simply because they present fever. Not only this leads to the waste of expensive drugs, but it also means that patients don’t receive treatment for their actual illness.

Faced with this problem, the World Health Organization introduced revised guidelines for malaria diagnosis and treatment in 2010. Antimalarial treatment should be restricted to patients whose malaria diagnostic result was positive (either through a blood slide or rapid diagnostic test). The National Malaria Control Programme in Tanzania has adopted these recommendations alongside the national scale-up of rapid diagnostic test distribution.

In Tanzania, the National Malaria Control Programme introduced revised guidelines for malaria diagnosis so that children would only receive a malaria treatment if the result of their rapid diagnostic test was positive.

In Afghanistan, where malaria incidence is much lower than in Africa, overdiagnosis is also a dangerous problem as patients with serious infectious are often left untreated.

What does this study add?
This study derives from and complements two ACT Consortium projects: the ”TACT trial” and ” Strategies for expanding access to quality malaria diagnosis in south-central Asia where malaria incidence is low”.

The research aims to describe the causes of illness in people up to 50 years old who present fever. It analyses cases in Tanzania (CONFIT study) and Afghanistan (CONFIA study) to identify infecting organisms responsible for non-malaria illnesses that cause fever, as well as to develop guidelines for better detecting and managing such illnesses.

The research team
Principal Investigators

Prof. Mark Rowland, London School of Hygiene & Tropical Medicine

Dr. Hugh Reyburn, London School of Hygiene & Tropical Medicine

Dr Helena Hildenwall, Karolinska Institutet, Sweden
Dr George Mtove, National Institute for Medical Research, Tanzania

Other Investigators

Prof Chris Whitty - London School of Hygiene & Tropical Medicine
Dr Toby Leslie - London School of Hygiene & Tropical Medicine
Ms Amy Mikhail - London School of Hygiene & Tropical Medicine
Dr Ismail Mayan - Health Protection and Research Organization (HPRO, Kabul)
Dr Nader Mohammed - HealthNet-TPO (Kabul)
Dr Fayaz Ahmed - Medical Emergency Relief International (Merlin, Kabul)
Dr Renata Mandike - Deputy Director, National Malaria Control Programme,Tanzania.
Prof Raimos Olomi - Professor of Paediatrics KCMC, Tanzania
Dr Steven Magesa - National Institute for Medical Research, Amani Centre, Tanga
Dr Clare Chandler - Lecturer in Social Science, London School of Hygiene & Tropical Medicine

Latest on this research
We have enrolled 1092 patients with ‘non-malarial febrile illness’ from Tanzania and approximately 550 from Afghanistan.

Laboratory analysis of samples from the CONFIT study (Tanzania) is currently ongoing in Nairobi.

Analysis from the CONFIA study (Afghanistan) has shown a high prevalence of Hepatitis A and B. Brucellosis (which can be transmitted to humans by contact with an infected animal or by drinking contaminated milk) and Q-fever (with a similar transmission path) are probably important diseases with an animal origin that cause fever.

It’s important to strengthen the quality of diagnosis at health services to improve the management of common causes of fever.