Improving fever management

TDR news item
14 March 2013

Fever management is an important issue crossing diseases and research areas. Fever is one of the key symptoms of malaria, but it can also signify pneumonia and other illnesses. WHO’s Global Malaria Programme and TDR are bringing together experts to identify research that can improve the management of fever.

This week recommendations on the topic are being discussed at the Global Malaria Programme’s Malaria Policy Advisory Committee (MPAC). An earlier meeting 22-24 January brought together over 50 experts to conduct a global review of evidence and practice on what is known in fever management in peripheral health care settings. Participants represented not only WHO departments of maternal, newborn, child and adolescent health; essential medicines; malaria; and pandemic and epidemic diseases; but also research organizations, donors, and NGOs.

Sometimes, successes create new challenges

The broader issue of fever management is growing out of success in malaria control. More children in low- and middle-income countries are now getting diagnosed and treated for malaria, and death rates are coming down. One of the main resulting questions is what to do about fever if malaria is no longer the most likely cause, and is instead pneumonia? In some areas, people are still being treated with antimalarials without a diagnosis, and that can lead to a number of problems:

  • Drug resistance
  • Inappropriate treatment
  • Higher treatment costs (paying for the wrong medication and needing a second treatment)

Communities play a critical role

The meeting participants were particularly interested in the role community members can play in both diagnosis and treatment of fever, which is an extension of what has already been shown to work – trained community workers able to diagnose and treat malaria. The Integrated Community Case Management (iCCM) task force was there to provide an overview of what is known and the research questions that lie ahead. Members include implementers, donors and research organizations that have developed a strategy to train, support and supply community health workers to provide diagnostics and treatments for pneumonia, diarrhea and malaria for sick children of families with difficult access to health facilities. It recently coordinated the publication of a special supplement on this issue in the American Journal of Tropical Medicine and Hygiene.

Research gaps

Managing fever will require new research in multiple areas. For example, which antibiotics are best? What is the role of the private sector, like drug shops, to help support diagnosis and treatment in remote areas? What is the best way to test anemic children in high malaria risk areas, and how can diagnostic tests be given in different conditions? Also flagged was the lack of guidelines for caring for adults with fever in community settings, and for children between ages 5 and 15, partly because research has focused on young children and pregnant women. The recommendations coming out of these meetings will be published in 2013.

For more information, please contact

Dr Johannes Sommerfeld
Telephone: +41 22 79 13954