Provider Practices in Non-Malarial Fevers: A Pilot Study in Malawi

Investigator: Kimberly Baltzell, RN, PhD, MS

Location(s): Malawi


Due to limited diagnostics capabilities and the ability to follow-up with patients, providers in malaria-endemic settings often struggle to accurately diagnose and appropriately treat non-malarial fever. The Global AIDS Interfaith Alliance (GAIA) provides health care via mobile clinics to 20,000 rural patients a month in Malawi, a country endemic with Plasmodium falciparum. Still, up to 50% of febrile patients that present to the mobile clinics test negative for malaria by rapid diagnostic test (RDT). We hypothesize that mobile clinic providers rely on RDTs to rule out malaria, but the diagnosis and management of non-malarial fevers is presenting a significant clinical challenge. We seek to test this hypothesis with a mixed-methods study with the following aims: 

(1) identify provider practice patterns in the diagnosis and management of non-malarial fever; 

(2) characterize providers’ practices and knowledge leading to the diagnosis and treatment of febrile patients in rural Malawi; and, 

(3) determine outcomes in malaria RDT-negative patients and identify those at highest risk of hospitalization or death. 

The results of this study will inform the development of a diagnostic and treatment algorithm for GAIA mobile clinics in Malawi. The overarching goal is to improve diagnostic accuracy and management of febrile patients in rural Africa.