Fever

In many African languages the word for “fever” and “malaria” are the same.  If your child has a fever in Malawi, your first thought should be, “Does my child have malaria?”  The good news is that malaria testing is readily available and only requires a simple fingerstick.  

The two types of malaria tests are: 

1. MRDT (malaria rapid diagnostic test)– this is the antibody test that is usually found in most home test kits. It’s a good idea to keep at least one home test kit in your medicine cabinet. Follow the package instructions as you only need a micro-drop of blood. Test when the fever spikes.  You should get results within 15 minutes.
2. MPS (malaria peripheral smear)- a smear of blood is placed on a slide and examined under the microscope. Parasites show up as little specs. Results will be listed as NPS (no parasites seen), 1+, 2+, 3+, or 4+.  Malaria tends to be more severe the higher the number, but that is not always the case. 

ABC Community Clinic is open 24 hours/7 days a week. If your child is generally looking well, but has a fever that you would normally watch and wait before you went to the clinic, feel free to order both MPS and MRDT from the cashier.  Both can be drawn from a simple finger stick. The nurse should give you results in 30 minutes. If negative, you can go home and proceed as listed below. If positive, you should see the clinician to start treatment for malaria.  Note that it is possible to get false negatives with both types of malaria testing and that the malaria tests should be repeated in 24 hours if the fever continues to cycle.

But, not every fever in Africa is malaria. In fact, fever is common in childhood.  The fever is an increase in body temperature as a part of the body’s immune response. The good news is that the fever helps fight off infections! Viruses and bacteria will not replicate as fast in higher temperatures. 

Questions to consider if your child has a fever:

1. How old is my baby? Any baby under 3 months of age that has a fever should be evaluated in person at the clinic.
2. Does my child have malaria?  Do not treat malaria at home. There can be many complications from malaria, so it is important that a health care provider is overseeing your child’s treatment and follow up.
3. How sick does my child look?  Does she look pathetic, lying around, holding onto me, breathing fast, no tears, very fussy or refusing to drink? Or is she smiling when you make a silly face, trying to steal her brother’s toy, drinking lots of juice, and making wet diapers?

As a general rule – “sick kids look sick!”  If your child, just looks “sick” and isn’t back to her playful self between fevers, then you should take her to the clinic.  If in doubt, call your health care provider or take her to the clinic.

4. How high is her temperature?  Any fever (>100.4 F or 38 C) for babies younger than 3 months needs to be seen at the clinic.  For older kids, your health care provider should be contacted for fevers over 102.2 degrees F or 39 degrees C.
5. Does she have a specific complaint along with the fever that needs to be evaluated? 
   • Make an appointment for: sore throat, earache, pain with urinating, rash, chronic illness, or mild vomiting and/or diarrhea.  
   • Emergency evaluation is needed for:  Non-stop crying; rash with purple spots; sluggish/trouble waking; blue lips, nails, or tongue; bulging or sunken soft spot; stiff neck; severe headache; drooling; trouble breathing; seizures; or moderate to severe abdominal pain with fever. 
6. How long has she had a fever?  Contact your health care provider if the fever lasts longer than 24 hours for kids under 2 and longer than 72 hours for older kids.  If a fever is lasting longer than 5 days, you should bring your child in for an evaluation. 
7. What can I do to make her feel better?  
   • Encourage her to drink fluids:  When a child has a fever, her heart beats faster and she breathes faster. As a result, she can get a little dehydrated.  The best thing you can do is to encourage her to drink water or juice to keep her hydrated.  Most kids with fevers don’t have a big appetite, but that will return when they are feeling better. Bring your child into the clinic if you can’t get her to drink anything.
   • Give her cuddles and snuggles:  When a little one is feeling sick, they often want to be held more than normal.  One of the best ways to help your child rest is to cuddle with her as you read her a book.
   • Remove extra layers:  In many cultures, people like to put thick blankets on kids that are sick. Each layer can add another degree of fever and add to dehydration from sweating, so best to stick to a thin blanket or single layer of comfortable clothes.
   • Let the fever do the work: If your child doesn’t seem to be too uncomfortable, then it’s best not to give medicine to reduce the fever. The fever helps fight off the infection by keeping the virus or bacteria from growing in the body.
   • If uncomfortable or fever higher that 102 degrees F or 38.9 degrees C, you may give:
     • Paracetemol (Panadol is the brand name. Same as acetaminophen or Tylenol) – Follow the package directions and don’t give more than the recommended dose. This medicine should not be given more than every 4 to 6 hours. Overdose can harm the liver.  (Caution: some over the counter cough syrups have paracetamol or Panadol in them and should not be used to avoid paracetamol overdose.)
     • Brufen (Motrin is the brand name. Ibuprofen is the same.) – This medicine should not be given to babies under six months. It has anti-inflammatory properties that help with pain and work well with high fevers.  Don’t give more often than every 6 hours. Be sure your child is well hydrated as this medicine could be harmful to the kidneys if dehydrated.