Seasoned medical experts have attributed the shift in malaria management, particularly the growing emphasis on strict clinical testing before treatment, to the increasing detection of fevers not caused by malaria parasites.
They explained that non-malarial fevers are not new but were long obscured by years of misdiagnosis, when virtually every fever was routinely presumed to be malaria without proper laboratory confirmation.
According to the experts, there is no reliable symptom that can confirm malaria without testing, as not every fever is malaria.
The best practice, they stressed, is to have a blood test to confirm the presence of malaria parasites, either through rapid diagnostic tests or microscopy.
They, however, noted that years of poor practice—where many people presenting with fever were treated for malaria without proper diagnostic tests contributed to the widespread assumption that all fever cases are caused by malaria.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.
According to the World Health Organisation, Nigeria accounts for approximately 27 per cent of global malaria cases and 32 per cent of malaria deaths. This is a huge drawback for a country battling other debilitating diseases.
In 2023 alone, an estimated 68 million Nigerians were diagnosed with malaria, and over 200,000 deaths were recorded, many of them children under five and pregnant women.
PUNCH Healthwise reports that the Lagos State Commissioner for Health, Prof. Akin Abayomi, disclosed that data shows that 95 out of every 100 fevers experienced in Lagos are not caused by malaria.
“We need to get malaria out of the region. It is very, very important that we do that once and for all, perform the mind shift in our healthcare providers that on average, 95 out of every 100 fevers that you may see are not caused by malaria,” Abayomi said at a three-day Study Kick-Off of Pathway to Pre-Elimination and Digitization Project in 2025.
Speaking exclusively to PUNCH Healthwise on the trend, the Strategic Adviser to the Coordinating Minister of Health and Social Welfare on Malaria Elimination in Nigeria, Prof. Olugbenga Mokuolu, said fever is a high body temperature that can be caused by many things.
Mokuolu noted that the rise in test results ruling out malaria as the cause of fever in most Nigerians was due to increased proper diagnostic testing.
“It is not that we are just beginning to have malaria-negative fever. It is not a new phenomenon. It has always been there. The issue is that, for many years, we were not doing the right things. As a result, most fevers were simply called malaria.
“Fever only means an elevation of body temperature. It can be caused by many different factors. From the beginning of medical training, it has always been taught that not all fevers are malaria.
“However, over time, especially in our environment, every fever gradually became synonymous with malaria. At a point, when people began to realise that not all fevers were malaria, the thinking shifted slightly to say that every fever was either malaria or typhoid. So, what we are dealing with is really decades of bad practice and poor quality of care,” he said.
According to the don, many people do not test before taking anti-malarial drugs.
“Many people do not test before taking anti-malarial drugs. They assume that because they have a fever, a bitter taste in the mouth, and joint pains, it must be malaria. They go to a chemist, receive anti-malarial medication, sometimes a combination of drugs, and once they feel better, they conclude that their ‘malaria’ has been treated.
“So, malaria-negative fever is not new. It has always been there. What is new is that proper testing has revealed the true proportion. The longstanding practice of treating every fever with anti-malarials has now been exposed as inaccurate,” he said.
Mokuolu, a professor of paediatrics at the University of Ilorin Teaching Hospital, Kwara State, reiterated that not all fevers are malaria, adding that most Nigerians were just operating based on default assumptions and making malaria the culprit in all fever cases.
“Even during the COVID-19 period, this principle applied. Not every fever was COVID-19, but testing was necessary to rule it out before considering other causes,” he said.
The strategic adviser explained that fever can result from several conditions.
“Broadly speaking, fever can result from bacterial infections, viral infections, parasitic infections such as malaria, malignancies, chronic infections like tuberculosis, or even drug reactions. Fever itself is simply a rise in body temperature. The real issue is identifying the underlying cause.
“So, when someone has a fever, the important question is not to assume it is malaria, but to determine what is actually causing it. That is the proper medical approach,” Mokuolu said.
According to him, it is also possible that the proportion of non-malaria fevers is increasing because malaria control efforts over the years have been yielding results.
“As malaria cases reduce, the proportion of fevers caused by other conditions naturally becomes more noticeable. Overall, fever cases may also decline as malaria-related fevers decrease,” he said.
The researcher said treating fever without testing the causative factor remains a dangerous gamble on one’s health.
“Every fever must be tested before treatment. We have seen the data. If only five out of 100 fever cases are actually malaria, how can you treat it without testing? If you do not test, you are gambling, and your probability of being correct is five out of 100. That is not a worthy gamble.
“So, whether you go to a chemist, a doctor, a nurse, or anywhere at all, if you or your child has a fever, you should demand a test. Let treatment be guided by the test result. If it is malaria, they will treat it. If it is not malaria, then attention can shift to other possible causes. That way, you do not waste precious time, which in some cases could cost a life,” he said.
The renowned malaria expert noted that when malaria treatment is started, Nigerians must endeavour to complete the treatment.
“Fever is common. But fever is caused by many things. Not all fevers are malaria. If malaria testing is negative and the provider is uncertain about the cause of fever, the patient should be referred to a more appropriate centre for proper evaluation. If malaria is confirmed, then ACT should be used, the treatment should be completed, and preventive strategies such as mosquito nets and environmental sanitation should continue,” he added.
Also speaking, a former National President, Association of Medical Laboratory Scientists of Nigeria, Dr. Toyosi Raheem, while clarifying the concept of fever, explained that it was not synonymous with malaria.
Dr Toyosi Raheem
“Normal body temperature is around 36.7 to 37.0 degrees Celsius. Once the temperature rises above that — say 37.5, 38, or 39 degrees — that is fever,” he said.
The former AMLSN president attributed two possibilities to why more cases of fever are not caused by malaria.
“When someone goes for a malaria test, and it comes back negative, there are two possible explanations. The first possibility is that the fever is not caused by malaria at all.
“The second possibility is that malaria could still be present, but at the time of testing, the concentration of the parasite in the peripheral blood is too low to be detected. We call this the limit of detection — meaning the parasite density in the blood is lower than what the testing device can detect at that moment,” he said.
Raheem, a Research Fellow at the Nigerian Institute of Medical Research, Yaba, Lagos, explained that the testing device could be microscopy using a microscope, or it could be a rapid diagnostic test kit.
“If the parasite concentration is below the detection threshold of the device used, the result may appear negative even though malaria parasites are present. So, those are the two interpretations: either the fever is not caused by malaria, or it is caused by malaria but the parasite density at the time of testing is below detectable levels,” he said.
The expert, however, emphasised that many infectious agents can cause fever.
“Bacteria, parasites like malaria, viruses, and fungi can all lead to elevated body temperature. So, not every fever is malaria. When fever is due to bacteria, you must determine where the infection is located, be it in the urinary tract, reproductive system, respiratory system, ear, nose and throat, bloodstream, or gastrointestinal tract. Identifying the source is critical for proper treatment,” Raheem added.
The African Region has the highest burden of malaria globally, with Nigeria being one of the top five countries with the highest incidence rate of 26 per cent, according to the World Malaria Report 2024.
Of the 263 million malaria cases estimated globally in 2023, Nigeria accounted for over 68 million cases and 194,000 deaths. It also accounted for 39.3 per cent of the global malaria deaths in children under five, with increasing cases between 2019 and 2023.
The Federal Government recently said over 24 million Nigerians tested positive for malaria between January and September 2025.
Credit: healthwise.punchng.com
