{"doi":"10.1111/tmi.13683","title":"Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania","abstract":"OBJECTIVES: In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010. METHODS: We compared diagnoses, treatments and outcomes from two hospital-based prospective cohort studies, Cohort 1 (2011-2014) and Cohort 2 (2016-2019), that enrolled febrile children and adults. All participants underwent quality-assured malaria blood smear-microscopy. Participants who were malaria smear-microscopy negative but received a diagnosis of malaria or received an antimalarial were categorised as malaria over-diagnosis and over-treatment, respectively. RESULTS: We analysed data from 2098 participants. The median (IQR) age was 27 (3-43) years and 1047 (50.0%) were female. Malaria was detected in 23 (2.3%) participants in Cohort 1 and 42 (3.8%) in Cohort 2 (p = 0.059). Malaria over-diagnosis occurred in 334 (35.0%) participants in Cohort 1 and 190 (17.7%) in Cohort 2 (p < 0.001). Malaria over-treatment occurred in 528 (55.1%) participants in Cohort 1 and 196 (18.3%) in Cohort 2 (p < 0.001). There were 30 (3.1%) deaths in Cohort 1 and 60 (5.4%) in Cohort 2 (p = 0.007). All deaths occurred among smear-negative participants. CONCLUSION: We observed a substantial decline in malaria over-diagnosis and over-treatment among febrile inpatients in northern Tanzania between two time periods after 2010. Despite changes, some smear-negative participants were still diagnosed and treated for malaria. Our results highlight the need for continued monitoring of fever case management across different malaria epidemiological settings in sub-Saharan Africa.","journal":"Tropical Medicine & International Health","year":2021,"id":201664,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.5124,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":345416,"name":"Matthew P. Rubach","orcid":"0000-0001-5262-1421","position":1,"is_corresponding":false},{"id":520528,"name":"John P. Bonnewell","orcid":"0000-0002-2886-4885","position":2,"is_corresponding":false},{"id":781101,"name":"Elena R. Cutting","orcid":null,"position":3,"is_corresponding":false},{"id":520529,"name":"Manuela Carugati","orcid":"0000-0002-3187-5905","position":4,"is_corresponding":false},{"id":780557,"name":"Nathaniel H. Kalengo","orcid":"0000-0002-5608-5520","position":5,"is_corresponding":false},{"id":372158,"name":"Michael J. Maze","orcid":"0000-0001-8909-1508","position":6,"is_corresponding":false},{"id":521322,"name":"Anne B. Morrissey","orcid":null,"position":7,"is_corresponding":false},{"id":341832,"name":"Blandina T. Mmbaga","orcid":"0000-0002-5550-1916","position":8,"is_corresponding":false},{"id":495858,"name":"Bingileki F. Lwezaula","orcid":"0000-0003-2909-9705","position":9,"is_corresponding":false},{"id":781102,"name":"Grace Kinabo","orcid":null,"position":10,"is_corresponding":false},{"id":780558,"name":"Ronald Mbwasi","orcid":"0000-0002-2365-5072","position":11,"is_corresponding":false},{"id":246929,"name":"Kajiru Kilonzo","orcid":"0000-0002-0367-5826","position":12,"is_corresponding":false},{"id":345414,"name":"Venance P. Maro","orcid":"0000-0003-3838-0312","position":13,"is_corresponding":false},{"id":22443,"name":"John A. Crump","orcid":"0000-0002-4529-102X","position":14,"is_corresponding":false},{"id":478837,"name":"Deng B. Madut","orcid":"0000-0003-4023-3928","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-18T23:50:56.394488Z","pmid":"34598312","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}