What is clinical malaria? Finding case definitions for field research in highly endemic areas

Abstract

In non-endemic areas, the diagnosis of clinical malaria may be made on the basis of fever and a positive blood film. However, in areas of high endemicity, asymptomatic parasitaemia is very common: to assume that a child who presents with fever and parasitaemia is ill from malaria will result in overdiagnosis. In this article, Jo Schellenberg, Tom Smith, Pedro Alonso and Richard Hayes discuss the relationship between fever and parasite density in such areas, and show how the proportion of fevers due to malaria (the attributable fraction) can be estimated and used to evaluate case definitions for use in field trials.