Be Aware: Not Every Fever in African Adults Is Caused By Malaria


By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team

Not Every Fever in Africa Is Caused By Maaria



  • Fever is a symptom, not a disease,
  • Fever occurs when body temperature exceeds its normal range,
  • The burden of fever in Africa is unknown owing to the wide range of contributing illnesses,
  • Common causes of fever vary across different regions in Africa,





One of the common complaints of most outpatients in primary healthcare centres in Africa is fever. And more often than not, the suspected culprit is malaria. 


Malaria is one of the major causes of fever in African Adults. Although it is still very prevalent, there have been interventions and a decrease in malaria cases in Sub-Saharan Africa. 


Still, many people consider malaria as the primary cause of fever. This has caused them to ignore other possible causes, resulting in the indiscriminate use of antimalarial drugs and oversight of life-threatening fever-related illnesses.


In 2010, the World Health Organization released a guideline for treating malaria. It stated that treatment should be based on the result of a malaria diagnostic test. With the use of malaria rapid diagnostic tests (RDTs), people who would have otherwise been treated for malaria are seen to be malaria-free. 


However, it is challenging to diagnose other fever-causing illnesses due to the wide range of possible causes and the lack of necessary diagnostic tests. Nevertheless, researchers have discovered several other causes of fever that you need to be aware of so you can make informed health decisions and diagnoses.  


This article will highlight several other causes of fever in African adults besides malaria. It will also discuss the types of fever, common symptoms and general knowledge of fever that you should know.



What is a Fever?


The normal human body has an average temperature of 98.6° F (37° C). However, sometimes, it can be as low as 97° F (36.1° C) or as high as 99.9° F (37.7° C). 


Whenever the body temperature exceeds this normal range, the condition is called fever. 



Causes of Fever in African Adults


While many causes of fever have been identified in Africa, there are other many unidentified causes. In fact, a recent study in East Africa revealed that up to 64% of fever cases over the years were of unknown causes.  


Also, the prevalence of the causes of fever may vary across countries in Africa. For instance, in contrast to bacterial zoonoses (zoonoses are infectious diseases transmitted from animal to man) which was a main cause of fever in the study carried out in East Africa, Guillebaud et al, found viral infections and malaria to be the main causes of fever in Madagascar.


Below are some of the causes of non-malarial fever across Africa.

  • Infectious Causes


Vector-Borne Diseases: Dengue fever, Yellow fever, African sleeping sickness (trypanosomiasis), Leishmaniasis, Zika Virus, schistosomiasis, filariasis, Crimean Congo Hemorrhagic Fever (CCHF), Chikungunya.


Viral Infections: HIV, influenza, viral hepatitis (A, B, C), Ebola virus disease, Lassa fever, Marburg virus disease, Rift Valley fever, and viral respiratory tract infections.


Bacterial Infections: Typhoid fever, Tuberculosis (TB), Bacterial meningitis, Cholera, Shigellosis, Brucellosis, Q fever, Enteric fever, Leptospirosis and Rickettsiosis.


Parasitic Infections: Amoebiasis, Giardiasis


Fungal infections: Candidiasis, Histoplasmosis, etc.


  • Non-Infectious Causes


Non-infectious causes of fever may include:

  • Autoimmune and inflammatory diseases
  • Cancers and haematological disorders
  • Environmental and occupational Factors (Heatstroke, Heat exhaustion)
  • Drug allergies or reactions
  • Thromboembolic conditions
  • Metabolic disorders
  • Severe dehydration
  • Ingestion of toxins and poisons


Given the wide range of contributing fever-related illnesses, there is no available data on the general burden of fever in African adults. Neither is there an estimate of the burden of death and disability from fever. However, these data may be available for more specific fever-causing diseases. 



Types of Fever in African Adults


Fever manifests in different patterns, giving rise to different types and classifications. There are three major types of fever namely;

  • Sustained/ Continuous fever
  • Intermittent fever
  • Remittent fever


Continuous or sustained fever does not fluctuate more than about 1° C (1.5° F) within 24 hours but does not drop to normal at any point either.


Intermittent fever is usually present only for several hours during the day 


Remittent fever is a fever with daily fluctuations above 2° C but does not drop to normal.


Fever can further be classified based on duration and based on high the body temperature is. 


Based on Duration, there are acute, sub-acute and chronic fevers.

  • Acute fever lasts for less than 7 days
  • Sub-acute fever lasts no more than two weeks
  • Chronic or persistent fever lasts for more than two weeks.


Based on how high the body temperature is, fever can be low grade, moderate grade, high grade and hyperpyrexia

  • Mild/low grade fever: 38.1° C – 39° C (100.5° F – 102.2 ° F)
  • Moderate grade fever: 39.1° C – 40° C     (102.2° F – 104.0° F)
  • High grade fever: 40.1° C – 41.1° C (104.1° F – 106.0° F)
  • Hyperpyrexia: >41.1° C (>106.0° F)



Common Symptoms Associated with Fever


Fever is a symptom of an illness. Hence, it does not cause many symptoms by itself except that;

  • You may feel cold and shiver
  • Your skin will become hot
  • You may sweat when the fever goes away or "breaks"


The majority of other symptoms that accompany fever in African adults are usually an indication of the underlying disease causing the fever. 


Some of the common associated symptoms of fever are;

  • Cough (Chest and upper respiratory tract infections, like pneumonia, tuberculosis, bronchiectasis, etc.
  • Weakness (or general fatigue)
  • Headache
  • Nasal congestion and/or discharge (Common cold, Allergies)
  • Fast heart rate (Infections generally)
  • Difficulty thinking (Blood infections or septicaemia)
  • Rash (Allergies, Auto-immune disorders, HIV/AIDS, etc.)
  • Shortness of breath or fast breathing (Heart and lung disorders) 
  • Weight loss (Tuberculosis, Cancers)
  • Pain 
  • Nausea and vomiting



Risk Factors for Fever in African Adults


Certain factors can increase your chances of getting a fever. Some of these factors are;

  • Your basic health status
  • Underlying chronic medical conditions like diabetes mellitus
  • Unsanitary habits
  • Exposure to an infected place, person or animal.
  • Your age
  • Certain job types
  • Some drugs (like immunosuppressants) or medical procedures



Diagnosis of Underlying Causes of Fever


After confirming that you have a fever by checking your temperature, your doctor will have to diagnose the possible cause of the fever.


First, your doctor will ask you a series of questions including;

  • Other symptoms
  • Medical history
  • Drugs that you are currently taking
  • Exposure to infections (place or recent travel, animal and contact with infected person)
  • Vaccination
  • Other medical procedures


Sometimes, pain can help with determining the possible cause of fever. So the doctor may ask if you experience pain in any part of your body.


Next, your doctor will perform a physical examination on you, checking all major organs of the body like the eyes, nose and throat, the skin, the chest, the heart, the abdomen, the pelvic organs, to identify whether you have evidence of abnormal function that may suggest the cause of your fever.


Your doctor may go on to recommend certain tests for you, especially if you are a person at risk. 


Possible tests that your doctor may recommend are;

  • A complete blood count
  • Urine and blood cultures
  • A chest x-ray
  • Urinalysis
  • C-Reactive Protein check
  • HIV/AIDS test
  • Imaging (CT scan or MRI, depending on need)
  • Etc.



Treatment of Fever in African Adults


  • General care and home remedies


Recall that fever is only an indication of an underlying illness. Hence, the best way to treat fever is to treat the cause.


However, sometimes, you may have a fever as a result of your body fighting an infection. Although fever itself is not dangerous (except when higher than about 106° F [41° C] in an adult, it can make you really uncomfortable and high fever can result in complications. 


Some general care and home remedies to consider include:

  • Drink plenty of fluids
  • Rest
  • Stay cool down by wearing light clothing and keeping room temperature down
  • Sleep with a light cover sheet 
  • Use common fever-reducing medications (antipyretics) like acetaminophen or ibuprofen as specified in the drug label or advised by your caregiver.
  • Keep a record of your temperature half-hourly or hourly to know if your home remedies are working. 
  • See your doctor if your fever continues for more than 3 days, or your temperature is 1040F (400C) and above. 


  • Cause-Specific Care


All cause-specific treatment of fever should only be on your doctor’s directive. Such treatments may include the use of the following classes of drugs:

  • Anti-infectives or antibiotics
  • Anti-inflammatory drugs
  • Anti-parasitic drugs
  • Anti-tuberculous drugs
  • Anti-cancer drugs
  • Pain medications
  • Etc. 



How to Prevent Fever in African Adults


Infections are the most common cause of fever. So the major means of prevention of fever in African adults is by making sure that you do not get infected. Some things you can do include to prevent infections include;

1. Maintain good hygiene and wash your hands regularly, especially after contact with an ill or infected person.

2. Use hand sanitisers that contain at least 60% alcohol. 

3. Avoid visiting places that increase your risk of infection.

4. Wear a nose mask in crowded places to prevent respiratory infections.

5. Take vaccinations if available.



Complications Associated with Fever


Most of the complications associated with fever are a result of the underlying illness. Therefore, there are many different possible complications depending on the cause of the fever. Although fever itself rarely results in complications, some possible ones are:

1. Dehydration: Fever sometimes causes sweating which in turn leads to dehydration if the body fluid is not replaced.

2. Confusion and delirium: High fever can lead to confusion, delirium, and other changes in mental status, especially in older adults and people with dementia.

3. Worsening of underlying conditions: In people with certain underlying conditions, such as heart failure or lung disease, fever can make their symptoms worse.

4. Organ failure: Very high body temperature can cause most body organs to malfunction and ultimately lead to their failure.

5. Seizures: Seizures due to high fever usually happen in young children. These are known as febrile seizures. Typically, this seizure should resolve within a minute or two.



When Should You See A Doctor?


You should see a doctor or nurse promptly if:

  • Your fever lasts longer than 3 days despite home remedies
  • Your temperature is 1040F (400C) and 24 hours and above
  • Your fever is accompanied by certain symptoms like:
    • Shortness of breath
    • Increased heart rate
    • Headache or stiff neck
    • Nausea and vomiting
    • Skin rashes
    • Confusion



FAQs About Fever in African Adults


  • What is the most common cause of fever in Africa?


The most common cause of fever may vary based on region. However, malaria is one of the most common causes of fever in African adults. Other common causes include bacterial zoonoses, respiratory infections, gastrointestinal infections, and vector-borne diseases.

  • Which is the deadliest fever in Africa?


Malaria remains one of the deadliest causes of fevers in Africa. Although there are other deadly causes in certain regions such as viral hemorrhagic fevers, malaria has a high prevalence in most parts of the continent.  

  • When Can I take over-the-counter fever-reducing medications?


You can take over-the-counter medications like acetaminophen (paracetamol) or ibuprofen, to bring down your fever temporarily and relieve your discomfort. Note however that they do not treat the underlying cause. It's important to talk with your healthcare provider for a proper diagnosis and treatment.


  • Are all fevers in Africa caused by infectious diseases?


No, not all fevers are caused by infectious diseases. Non-infectious causes of fever can include autoimmune diseases, heat-related illnesses, drug reactions, and more.


  • What role does climate and seasonality play in fever outbreaks in Africa?


Climate and seasonality can influence the occurence of diseases worldwide and also in Africa. For instance, malaria may have higher transmission rates during the rainy season. Understanding these patterns is essential for prevention and control efforts.





Although malaria is one of the major causes of fever in African adults, there are several other causes of fever that are often neglected. One study carried out in Northern Tanzania revealed that of the 56.7% of adults whom interviewees perceived to have malaria, only 2.0% actually had malaria. Moreover, bacterial zoonoses were the most common cause of fever, but no interviewee mentioned infections from animal contact as a common cause.  


Hence, there is a need for more enlightenment on the other common causes of fever. For medical workers, it will be useful to establish a system for tracking fever cases. This will help doctors figure out what's causing the fever and improve how they treat patients with fever-related illnesses.




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2. Guillebaud J, Bernardson B, Randriambolamanantsoa TH, Randrianasolo L, Randriamampionona JL, Marino CA, et al. Study on causes of fever in primary healthcare center uncovers pathogens of Public Health Concern in Madagascar. PLOS Neglected Tropical Diseases. 2018;12(7). doi:10.1371/journal.pntd.0006642

3. Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Tropical Medicine & International Health. 2013;18(11):1406–15. doi:10.1111/tmi.12191 

4. Nooh F, Chernet A, Reither K, Okuma J, Brattig NW, Utzinger J, et al. Prevalence of fever of unidentified aetiology in East African adolescents and adults: A systematic review and meta-analysis. Infectious Diseases of Poverty. 2023;12(1). doi:10.1186/s40249-023-01105-z 

5. Ogoina D. Fever, fever patterns and diseases called ‘fever’ – A Review. Journal of Infection and Public Health. 2011;4(3):108–24. doi:10.1016/j.jiph.2011.05.002 


Related: Fever in children: What African parents need to know



Published: November 10,, 2023

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