Affiliations: Biochemistry and Nutrition Division, Nigerian
Institute of Medical Research, Yaba-Lagos, Nigeria | Department of Medical Microbiology and Parasitology,
Olabisi Onabanjo University, Sagamu, Nigeria | Health Care Centre Iru-Victoria Island, Lagos,
Nigeria | Maternal and Child Health Complex, General Hospital,
Ikorodu, Lagos, Nigeria
Note:  Correspondence: Dr. Bamidele Iwalokun, Biochemistry and
Nutrition Division, Nigerian Institute of Medical Research, PMB. 2013 Yaba,
Lagos, Nigeria. Tel.: +234 1 8023357646; Fax: +234 1 792140; E-mail:
Abstract: This study determined the trends of fever in relation to
parasitaemia and established Pyrogenic threshold (PYT) for malaria in Nigerian
children. Two cross-sectional surveys of malaria and fever were carried out
during the dry and rainy seasons of 2007 and 2008 in children aged 6 mo
−11 yr attending two Primary Health Care Centres (PHC) in Lagos, Nigeria.
Structured questionnaires were used to capture data. A total of 505 children
attending PHC during the rainy (n = 385) and dry (n=116) seasons were studied.
Unlike in the dry season, the parasite rate increased with age until 59 mo
during the rainy season, while both fever rate (19.7–25.4% vs.
14.1–17.7%) and parasite and fever rate combined (13.4–16.7% vs.
9.2–11.2%) showed a decrease with increasing age. More febrile cases with
parasitaemia occurred in children aged 23 mo and below compared to those within
the 24–59 mo age bracket during the rainy season only (P < 0.05). For
all the age groups combined, mean PYT of 2675 and 3000 parasite/uL in 2007 and
2008 during the rainy season and 610 parasites/uL during the dry season (both
years) were found. The use of non-artemisinin based combination interventions
by caregivers increased the PYT, by 0.5–8.4%. We conclude that fever has
become less reliable for syndromic diagnosis of malaria in children below 5 yr
in this environment, and that laboratory confirmation of the diagnosis should
be mandatory in all cases.
Keywords: Plasmodium falciparum, malarial fever, pyrogenic threshold, Nigerian children