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Reference: Elmardi, KA, Noor, AM, Githinji, S et al., (2011). Self-reported fever, treatment actions and malaria infection prevalence in the northern states of Sudan. Malaria journal, 10 (1), 128.Citable link to this page:


Self-reported fever, treatment actions and malaria infection prevalence in the northern states of Sudan.

Abstract: BACKGROUND: The epidemiology of fevers and their management in areas of low malaria transmission in Africa is not well understood. The characteristics of fever, its treatment and association with infection prevalence from a national household sample survey in the northern states of Sudan, an area that represents historically low parasite prevalence, are examined in this study. METHODS: In October-November 2009, a cluster sample cross-sectional household malaria indicator survey was undertaken in the 15 northern states of the Sudan. Data on household assets and individual level information on age, sex, whether the individual had a fever in the last 14 days and on the day of survey, actions taken to treat the fever including diagnostic services and drugs used and their sources were collected. Consenting household members were asked to provide a finger-prick blood sample and examined for malaria parasitaemia using a rapid diagnostic test (RDT). All proportions and odds ratios were weighted and adjusted for clustering. RESULTS: Of 26,471 respondents 19% (n = 5,299) reported a history of fever within the last two weeks prior to the survey and 8% had fever on the day of the survey. Only 39% (n = 2,035) of individuals with fever in last two weeks took any action, of which 43% (n = 875) were treated with anti-malarials. About 44% (n = 382) of malaria treatments were done using the nationally recommended first-line therapy artesunate+sulphadoxine-pryrimethamine (AS+SP) and 13% (n = 122) with non-recommended chloroquine or SP. Importantly 33.9% (n = 296) of all malaria treatments included artemether monotherapy, which is internationally banned for the treatment of uncomplicated malaria. About 53% of fevers had some form of parasitological diagnosis before treatment. On the day of survey, 21,988 individuals provided a finger-prick blood sample and only 1.8% were found positive for Plasmodium falciparum. Infection prevalence was higher among individuals who had fever in the last two weeks (OR = 3.4; 95%CI = 2.6 - 4.4, p < 0.001) or reported fever on the day of survey (OR = 6.2; 95%CI = 4.4 - 8.7, p < 0.001) compared to those without a history of fever. CONCLUSION: Across the northern states of the Sudan, the period prevalence of fever is low. The proportion of fevers that are likely to be malaria is very low. Consequently, parasitological diagnosis of all fevers before treatment is an appropriate strategy for malaria case-management. Improved regulation and supervision of health workers is required to increase the use of diagnostics and remove the practice of prescribing artemisinin monotherapy.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Global Fund to Fight Aids, Tuberculosis and Malaria   Notes:© 2011 Elmardi et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bibliographic Details

Publisher: BioMed Central Ltd.

Publisher Website:

Journal: Malaria journalsee more from them

Publication Website:

Issue Date: 2011


Urn: uuid:789b3320-d251-49c4-a3af-94cbec59b46d

Source identifier: 154824

Eissn: 1475-2875


Issn: 1475-2875 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Humans Plasmodium falciparum Parasitemia Malaria, Falciparum Prevalence Family Characteristics Adolescent Adult Aged Aged, 80 and over Child Child, Preschool Infant, Newborn Infant Antimalarials Middle Aged Young Adult Cross-Sectional Studies Sudan Female Fever of Unknown Origin Male Tiny URL: pubs:154824


Autor: Elmardi, KA - - - Noor, AM - institutionUniversity of Oxford grantNumber081829 fundingWellcome Trust - - - Githinji, S - - - Abde



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