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A series of articles that set out to explore the global distribution of infections that cause non-malarial febrile illness has been published in BMC Medicine. The series brings together the results of large-scale systematic reviews of the causes of fever in Africa, Latin America, and Southern and South-Eastern Asia, and has helped identify major knowledge gaps, geographical differences, priority areas for diagnostics research and development, and enabled the most comprehensive systematic review of literature to date.

Mother and newborn © Arne Hoel World Bank

Febrile illness is the most common reason for childhood healthcare visits globally, with hundreds of millions of cases of fever in 0 to four-year-olds presenting at health facilities every year. Historically, in malaria-endemic countries it was assumed that malaria was the cause of fever, but with the advent of rapid diagnostic tests (RDTs) for malaria, combined with intensified malaria control activities over the last decade, the incidence rate of malaria has been substantially reduced. Health workers and researchers have noted that once malaria is ruled out, it is difficult to diagnose febrile illness due to limited diagnostic tools, laboratory facilities and the scarcity of comprehensive surveillance networks in low-resource settings. Thus, patients with fever are often misdiagnosed and given inappropriate treatments, such as antibiotics in the absence of a confirmed diagnosis, which in addition to mistreating individual patients may contribute to antimicrobial resistance.

Today, the ongoing pandemic of COVID-19, a disease with a potential presentation of non-specific febrile illness, further highlights the need for accurate diagnostics, strong surveillance networks and standardized data to efficiently handle this disease alongside addressing the multitudes of causes of potentially co-existing non-malarial febrile illnesses.

In order to map the main causes of fever in all malaria-endemic regions, researchers associated with the WorldWide Antimalarial Resistance Network (WWARN); the Infectious Diseases Data Observatory (IDDO) at the University of Oxford, the Foundation for Innovative New Diagnostics (FIND), London School of Hygiene & Tropical Medicine (LSHTM), University of Otago, University of Hong Kong, Fundação Oswaldo Cruz (Fiocruz), and the MORU Tropical Health Network - Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU) and Cambodia-Oxford Medical Research Unit (COMRU) screened more than 100,000 articles published between 1980 and 2015 to provide the most comprehensive data available to date.

Read the full story on the IDDO website