Misdiagnosis of non-malaria febrile infectious diseases as malaria in Nigeria: consequences and priority actions

Fever means a body temperature that is above normal. It is the most common symptom people seeking health care present with at health facilities. There are many etiologies of fever but the most common is infection (viral, bacterial, fungal or protozoan) and malaria is the most commonly incriminated in tropical countries including Nigeria. This is due to the endemicity of the disease in these regions, yet ‘endemicity’ is not synonymous with ‘will have malaria’. Malaria keep being over diagnosed in fever cases in these regions while other etiologies of fever are being overlooked and un-investigated resulting in poor patient outcome amongst other public health issues such as antimalarial resistance and patient mismanagement. Other non-malaria infectious diseases commonly misdiagnosed as malaria include bacterial sepsis, arbovirus infection, otitis media in children and so on. Studies have revealed that a lot of febrile patients are being misdiagnosed as having malaria and are being treated with an antimalarial drug they do not need. Factors responsible for this misdiagnosis include lack of awareness/bias, lack of fever management policy, human resource for health challenge and outdated/cumbersome diagnostic tools. Consequences of misdiagnosis include resistance to expensively researched antimalarial drugs, economic loss, prolonged suffering of patient, risk of death and risk of epidemic outbreak. The way out includes awareness that all fever cases are not malaria, implementation of fever management policy, research to establish other etiologies of fever in Nigeria other than malaria, testing for other etiologies of fever alongside malaria and use of better diagnostic tools for fever diagnosis.