Identifying populations with high prevalence of non-malarial febrile illnesses across different demographic groups in Malawi

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BACKGROUND: Malaria remains a major cause of febrile illness in Malawi; however, the epidemiology of non-malarial febrile illnesses (NMFIs) is less well characterized. Understanding the distribution and determinants of NMFIs across demographic groups is essential for improving case management in malaria-endemic settings. OBJECTIVES: This study aimed to characterized the distribution and predictors of NMFIs among preschool-aged children (PSC), school-aged children (SAC), women of reproductive age (WRA), and men in Malawi. METHODS: Secondary data from the 2015-2016 Malawi Micronutrient Survey were analyzed. Multivariable logistic regression models were fitted separately for each population subgroup to identify factors independently associated with NMFIs. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. RESULTS: The prevalence of NMFIs was highest among PSC (27.0%) and lowest among men (9.1%). Asymptomatic malaria was most common in SAC (28.6%), while symptomatic malaria was highest in PSC (15.9%). Among PSC, age 24-35 months (aOR = 2.5; 95% CI 1.4-4.6), recent diarrhea (aOR = 1.6; 95% CI 1.1-2.5), recent cough (aOR = 3.8; 95% CI 2.5-5.7), wasting (aOR = 2.2; 95% CI 1.0-4.8), and urban residence (aOR = 1.9; 95% CI 1.0-3.5) were associated with increased odds of NMFIs. In SAC, WRA, and men, recent cough was a consistent predictor of NMFIs (aOR = 1.9; 95% CI 0.9-4.2; aOR = 3.1; 95% CI 1.7-5.8; and aOR = 44.3; 95% CI 10.2-192.8, respectively). Among WRA and men, elevated alpha-1-acid glycoprotein levels were also associated with higher odds of NMFIs (aOR = 2.2; 95% CI 1.0-4.8 and aOR = 4.5; 95% CI 1.0-86.4, respectively). CONCLUSION: PSC bear the highest burden of NMFIs and symptomatic malaria, while SAC commonly harbor asymptomatic malaria. Febrile illness management should move beyond malaria-focused approaches to include integrated screening for common non-malarial infections, particularly in young children.

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