{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:22:55Z","timestamp":1781522575156,"version":"3.54.1"},"reference-count":0,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,2]]},"abstract":"<jats:title>Abstract.<\/jats:title><jats:p>In endemic settings where asymptomatic malaria infections are common, malaria infection can complicate fever diagnosis. Factors influencing fever misdiagnosis, including accuracy of malaria rapid diagnostic tests (mRDTs) and the malaria-attributable fraction of fevers (MAF), require further investigation. We conducted facility-based surveillance in Malawi, from January 2012 through December 2013 in settings of high perennial (Chikhwawa), high seasonal (Thoylo), and moderate seasonal (Ndirande) malaria transmission. Consecutive patients presenting to outpatient departments were screened; those with suspected malaria illness were tested by mRDT or routine thick-smear microscopy. Test positivity rates (TPRs), positive predictive value (PPVs) of mRDTs, and MAFs were calculated by site, age, and season. Of 41,471 patients, 10,052 (24.2%) tested positive for malaria. The TPR was significantly greater in Chikhwawa (29.9%; 95% CI, 28.6\u201330.0) compared with Thyolo (13.2%; 95% CI, 12.5\u201313.7) and Ndirande (13.1%; 95% CI, 12.2\u201314.4). The overall PPV was 77.8% (95% CI, 76.8\u201378.7); it was lowest among infants (69.9%; 95% CI, 65.5\u201374.2) and highest among school-age children (81.9%; 95% CI, 80.3\u201383.4). Malaria infection accounted for about 50% of fevers in children younger than 5 years old with microscopy-confirmed <jats:italic>Plasmodium falciparum<\/jats:italic> infection, and less than 20% of such fevers in school-age children. Outpatient settings in Malawi had a high burden of malaria illness, but also possible overdiagnosis of malaria illness. Interventions to reduce malaria transmission and rapid testing for other common febrile illness may improve diagnostic clarity among outpatients in malaria endemic settings.<\/jats:p>","DOI":"10.4269\/ajtmh.20-1209","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T14:32:59Z","timestamp":1620052379000},"page":"2123-2130","source":"Crossref","is-referenced-by-count":10,"title":["Overdiagnosis of Malaria Illness in an Endemic Setting: A Facility-Based Surveillance Study in Malawi"],"prefix":"10.4269","volume":"104","author":[{"given":"Ingrid","family":"Peterson","sequence":"first","affiliation":[{"name":"1Center for Vaccine Development and Global Health, University of Maryland Baltimore, Baltimore, Maryland;"},{"name":"2Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atupele","family":"Kapito-Tembo","sequence":"additional","affiliation":[{"name":"3Malaria Alert Center, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Bauleni","sequence":"additional","affiliation":[{"name":"3Malaria Alert Center, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osward","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"2Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Pensulo","sequence":"additional","affiliation":[{"name":"2Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Still","sequence":"additional","affiliation":[{"name":"1Center for Vaccine Development and Global Health, University of Maryland Baltimore, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarissa","family":"Valim","sequence":"additional","affiliation":[{"name":"4Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Cohee","sequence":"additional","affiliation":[{"name":"1Center for Vaccine Development and Global Health, University of Maryland Baltimore, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrie","family":"Taylor","sequence":"additional","affiliation":[{"name":"5Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don P.","family":"Mathanga","sequence":"additional","affiliation":[{"name":"3Malaria Alert Center, College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam K.","family":"Laufer","sequence":"additional","affiliation":[{"name":"1Center for Vaccine Development and Global Health, University of Maryland Baltimore, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/104\/6\/article-p2123.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/104\/6\/article-p2123.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T16:40:15Z","timestamp":1622652015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/104\/6\/article-p2123.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,2]]},"references-count":0,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.20-1209","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,2]]}}}