10 Common Causes of Fever in Children in Sub-Saharan Africa 

By Promise Oladejo, Freelance Health Writer and DLHA Volunteer. Medically reviewed by: T. Oyetunji, MBBS, FWACP

 

Happy African children running together outdoors. Image credit: Freepik

 

Highlights

• Fever in children is often a sign of an underlying infection, ranging from mild to severe.
• Malaria, respiratory infections, and diarrheal diseases are leading causes of fever in Sub-Saharan Africa.
• Meningitis, tuberculosis and certain autoimmune conditions can cause persistent fever and require urgent medical evaluation. 
• Seek medical help if fever lasts over 48 hours, exceeds 40°C (104°F), or is accompanied by severe features such as seizures (uncontrollable shaking), or dehydration.

 

Introduction

Fever is a common symptom in children, often signaling an underlying illness. It is not a disease itself but a sign that the body is fighting an infection.

In Sub-Saharan Africa, fever in children can be caused by various infections, ranging from mild viral illnesses to severe bacterial infections. Misdiagnosis and inappropriate treatment, particularly the overuse of antimalarial and antibiotic medications, remain major challenges in fever management (1). This article explores the ten most common causes of fever in children in the region, their symptoms, and when to seek medical attention.

 

1. Malaria

Malaria remains one of the leading causes of fever in children in Sub-Saharan Africa. It is transmitted through mosquito bites and caused by Plasmodium parasites, with Plasmodium falciparum being the most dangerous (2). Symptoms include: 

• High fever with chills and sweating 
• Fatigue and weakness 
• Headache and body aches 
• Vomiting and diarrhea in some cases

Children with malaria often have fluctuating fevers that come in cycles. Malaria rapid diagnostic tests (RDTs) are widely available, but misdiagnosis still occurs due to reliance on clinical symptoms rather than laboratory confirmation (3).

 

2. Upper Respiratory Infections (e.g., Common Cold and Flu, Tonsillitis)

Mild viral infections such as the common cold and flu frequently cause fever in children (6). Viral tonsillitis can also lead to fever, but bacterial tonsillitis is often associated with high fever. Symptoms of the common cold and flu include:

• Runny or stuffy nose 
• Sore throat and difficulty swallowing 
• Cough and sneezing 
• Low to moderate fever 

Most viral infections are self-limiting, but bacterial tonsillitis, most often caused by Streptococcus pyogenes, may require antibiotics to prevent complications such as rheumatic fever. 

 

3. Lower Respiratory Infections (e.g., Pneumonia, COVID-19)

Respiratory infections are among the most common causes of fever in children (4). Pneumonia, often caused by bacteria infections (germs) such as Streptococcus pneumoniae and Haemophilus influenzae, is a major concern. Symptoms include: 

• Fast or difficulty breathing 
• Persistent cough 
• Fever with chills 
• Chest pain (in older children) 

Viral infections like influenza and parainfluenza also contribute to febrile illnesses, though they tend to be milder in most children (5).

 

4. Diarrheal Diseases

Gastrointestinal infections, often caused by Salmonella, Shigella, Escherichia coli, and Rotavirus, are a leading cause of fever in children (7). These infections typically result from consuming contaminated food or water. Symptoms include:

• Watery or bloody diarrhea
• Vomiting and nausea 
• Fever and dehydration

Severe dehydration is a medical emergency requiring immediate attention.

 

5. Urinary Tract Infections 

Urinary tract infections (UTIs) are a significant and potentially under-recognized cause of fever in young children, particularly in when fever occurs without a clear source (8). Bacterial infections, mainly by Escherichia coli, can affect the bladder or kidneys. Symptoms include: 

• Fever without other obvious symptoms 
• Pain or burning sensation during urination 
• Frequent urination or bedwetting 
• Abdominal or lower back pain 

A urine test is needed for accurate diagnosis.

 

6. Ear Infections

Otitis media, a bacterial or viral infection of the middle ear, is a common cause of fever in children (9). Symptoms include: 

• Ear pain and pulling at the ear 
• Ear discharge (drainage of fluid or pus from the ear)
• Hearing difficulties 
• Irritability and poor feeding 

Ear infections often follow a cold or respiratory infection and may require antibiotics if caused by bacteria.

 

7. Measles and Other Viral Diseases

Measles remains a public health issue in Sub-Saharan Africa, particularly in areas with low vaccination rates (10). Symptoms include:

• High fever
• Runny nose and cough
• Red eyes and white spots inside the mouth
• Rash that starts on the face and spreads downward

Other viral causes of fever include rubella, mumps, and dengue fever.

 

8. Tuberculosis

While Tuberculosis (TB) is more common in adults, children with prolonged fever and weight loss should be tested, especially if they have been in contact with an adult with tuberculosis. Symptoms include: 

• Persistent low-grade fever 
• Night sweats 
• Chronic cough 
• Weight loss and poor appetite 

TB diagnosis requires a combination of skin tests, chest X-rays, and sputum analysis.

 

9. Meningitis

Meningitis, caused by bacteria like Neisseria meningitidis and Streptococcus pneumoniae, is a life-threatening condition requiring urgent medical care (11). Symptoms include: 

• High fever with severe headache 
• Neck stiffness and sensitivity to light 
• Vomiting 
• Seizures and confusion 

Delayed treatment increases the risk of complications, including brain damage and death.

 

10. Autoimmune and Other Rare Conditions

Although less common, autoimmune disorders such as systemic juvenile idiopathic arthritis (sJIA) can cause recurrent fevers (12). Autoimmune disorders are conditions that occur when the body mistakes its own healthy tisues as foreign and attacks them. Symptoms vary but may include:

• Prolonged unexplained fever 
• Skin rashes 
• Joint swelling and pain 

These conditions require specialist evaluation and treatment.

 

When to Seek Medical Help

Parents and caregivers should seek immediate medical attention if a child with fever exhibits any of the following warning signs (13): 

Talk to a doctor if your child runs a fever for more than three days

 

• Temperature exceeding 40°C (104°F)
• Fever persisting for more than three days
• Signs of hyperthermia (extremely high fever) (e.g., Muscle stiffness, mental changes)
• Symptoms suggesting serious underlying issues (e.g., Severe pain, Breathing problems)

 

Conclusion

Fever in children is common and often resolves on its own. However, recognizing its underlying cause is crucial for proper treatment. Malaria, respiratory infections, diarrhea, UTIs, and meningitis are among the leading causes of fever in children in Sub-Saharan Africa. Parents should be aware of warning signs that require medical intervention and avoid unnecessary use of antibiotics and antimalarials. Improving public health education and access to better diagnostic tools will enhance fever management and reduce child mortality in the Sub-Saharan Africa region. 

 

References:

1. Rautman LH, Maiga?Ascofaré O, Eibach D, Hogan B, Dekker D, Jaeger A, Akenten CW, Owusu?Dabo E, Boateng FO, Hanson H, Boahen KG. Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana—A longitudinal hospital study. Tropical Medicine & International Health. 2024 Mar;29(3):206-13. Available from here.

2. Iroh Tam PY, Obaro SK, Storch G. Challenges in the etiology and diagnosis of acute febrile illness in children in low-and middle-income countries. Journal of the Pediatric Infectious Diseases Society. 2016 Jun 1;5(2):190-205. Available from here. 

3. Nooh F, Chernet A, Reither K, Okuma J, Brattig NW, Utzinger J, Probst-Hensch N, Paris DH, Dreyfus A. Prevalence of fever of unidentified aetiology in East African adolescents and adults: a systematic review and meta-analysis. Infectious Diseases of Poverty. 2023 May 25;12(1):55. Available from here. 

4. Kiemde F, Tahita MC, Lompo P, Rouamba T, Some AM, Tinto H, Mens PF, Schallig HD, van Hensbroek MB. Treatable causes of fever among children under five years in a seasonal malaria transmission area in Burkina Faso. Infectious diseases of poverty. 2018 Jun 1;7(03):35-44. Available from here. 

5. D'acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B. Beyond malaria—causes of fever in outpatient Tanzanian children. New England Journal of Medicine. 2014 Feb 27;370(9):809-17. Available from here.

6. Oshikoya KA, Senbanjo IO. Fever in children: Mothers' perceptions and their home management. [Internet]. Tehran University of Medical Sciences Press. 2009 January 21. [Cited March 26, 2025. Available from here. 

7. Kiemde F, Spijker R, Mens PF, Tinto H, Boele M, Schallig HD. Aetiologies of non?malaria febrile episodes in children under 5 years in sub-Saharan Africa. Tropical Medicine & International Health. 2016 Aug;21(8):943-55. Available from here. 

8. Gonzalez M, Salmon A, Garcia S, Arana E, Mintegi S, Benito J. Prevalence of urinary tract infection in infants with high fever in the emergency department. Anales de Pediatría (English Edition). 2019 Dec 1;91(6):386-93. Available from here.

9. Green R, Webb D, Jeena PM, Wells M, Butt N, Hangoma JM, Moodley RS, Maimin J, Wibbelink M, Mustafa F. Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa. African Journal of Emergency Medicine. 2021 Jun 1;11(2):283-96. Available from here. 

10. Adeboye A, Yusuf RA, Ige OK. Fever: a literature review of perceptions, perspectives and practices. J Tradit Med Clin Naturop. 2017;6:249. Available from here. 

11. Fernandes JF, Held J, Dorn M, Lalremruata A, Schaumburg F, Alabi A, Agbanrin MD, Kokou C, Ben Adande A, Esen M, Eibach D. Causes of fever in Gabonese children: a cross-sectional hospital-based study. Scientific reports. 2020 Feb 7;10(1):2080. Available from here. 

12. Ostring GT, Singh?Grewal D. Periodic fevers and autoinflammatory syndromes in childhood. Journal of Paediatrics and Child Health. 2016 Sep;52(9):865-71. Available from here.

13. Laupland KB. Fever in the critically ill medical patient. Critical care medicine. 2009 Jul 1;37(7):S273-8. Available from here.

 

Related: 

• Fever in children: What African parents need to know
• Chest Infection in African Children
• Common Cold in Babies: What African Parents Should Know
• Teething in Babies: What African Parents Should Know
• African Parents, Can You Tell If Your Baby Has Common Cold or Chest Infection?
• Chest Infection in African Children
• Earache in Young African Children: Causes, Signs and Treatment
• Teething in Babies: What African Parents Should Know

 

 

Published: May 29, 2025

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