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Identifying causes of fever in children under five in Zanzibar

[Project summary in Français / Português]

Scientific title: Infectious disease aetiologies of uncomplicated febrile illness in children <5 years of age in rural Zanzibar

Latest on this research

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Learn more about our main study in Zanzibar, 'Trusting rapid diagnostic tests in Zanzibar'.

What did we know before this research?

Over the past decade, Zanzibar has adopted artemisinin-based combination therapy (ACT), long lasting insecticide treated nets and indoor residual spraying. As a result, Zanzibar has turned into a low transmission area with a decline of P. falciparum malaria among children with fever from approximately 30% to 1%, as well as a significant reduction of the crude child mortality. Based on these results, the Zanzibar Ministry of Health officially decided to change the target from control to elimination of malaria.

In order to reach this target, Zanzibar requires a system that provides ACT drugs only to patients who have received a formal positive diagnosis (detection of malaria parasites in the blood). Giving ACT to people who do not have malaria not only leads to the waste of expensive drugs and causes a financial burden on the health care system, but it may prevent other causes of fever from being appropriately treated. This may also increase the risk of drug resistance which could have a devastating effect on global efforts to control the disease.

What does this study add?

Zanzibar has introduced the use of rapid diagnostic tests in all public health facilities as a diagnosis mechanism that confirms the presence of malaria parasites in the blood. The tests are proposed to improve the efficiency of diagnosis, especially in remote areas where microscopy services – a laboratory-based, complex and more expensive diagnosis method – are limited.

This is a complementary study that developed from the main project, “Trusting rapid diagnostic tests in Zanzibar”. It aims to understand why children under five years old develop fever that is caused by non-malaria illnesses including pneumonia and diarrheal infections. It also assesses how rapid diagnostic tests within the Integrated Management of Childhood Illness (IMCI) determine whether patients require ACT or antibiotic.

Nurses and lab technicians took a number of laboratory tests for all children presenting with fever. Some of the samples were later transported to Sweden for PCR based analysis to detect bacteria and viruses.  

The research team

Principal Investigator

  • Professor Anders Björkman, Karolinska Institutet


  • Mr. Mwinyi I. Msellem, Zanzibar Malaria Control Program, Zanzibar 


Other Investigators

  • Dr. Kristina Elfving, University of Gothenburg
  • Dr. Andreas Mårtensson, Karolinska Institutet
  • Dr. Delér Shakely, Karolinska Institutet
  • Mr. Abdullah S. Ali, Zanzibar Malaria Control Program

Research Themes

Related Publications

Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar

Kimberly Baltzell, Kristina Elfving, Deler Shakely, Abdullah S Ali, Mwinyi Msellem, Shilpa Gulat and Andreas Mrtensson,  |  Published
Malaria Journal

Real-time PCR threshold cycle (Ct) cut-offs help to identify agents causing acute childhood diarrhea in Zanzibar

Kristina Elfvinga, Maria Andersson, Mwinyi I. Msellem, Christina Welinder-Olsson, Max Petzold, Anders Bjrkman, Birger Trollfors, Andreas Mrtensson and Magnus Lindha  |  Published
Journal of Clinical Microbiology

Pneumococcal concentration and serotype distribution in preschool children with radiologically confirmed pneumonia compared to healthy controls prior to introduction of pneumococcal vaccination in Zanzibar: an observational study

Kristina Elfving, Lucia Gonzales Strömberg, Shadi Geravandi, Maria Andersson, Marc Bachelard, Mwinyi Msellem, Delér Shakely, Birger Trollfors, Rickard Nordén, Andreas Mårtensson, Anders Björkman, Magnus Lindh  |  Published
BMC Infectious diseases

Pathogen Clearance and New Respiratory Tract Infections Among Febrile Children in Zanzibar Investigated With Multitargeting Real-Time Polymerase Chain Reaction on Paired Nasopharyngeal Swab Samples

Kristina Elfving, Deler Shakely, Maria Andersson, Kimberly Baltzell, Mwinyi I Msellem, Anders Björkman, Andreas Mårtensson, Max Petzold, Birger Trollfors, Magnus Lindh  |  Published
The Pediatric infectious disease journal

Coinfection with Enteric Pathogens in East African Children with Acute Gastroenteritis-Associations and Interpretations

Maria Andersson, Jean-Claude Kabayiza, Kristina Elfving, Staffan Nilsson, Mwinyi I Msellem, Andreas Mårtensson, Anders Björkman, Tomas Bergström, Magnus Lindh  |  Published
The American journal of tropical medicine and hygiene

Rapid Clearance and Frequent Reinfection With Enteric Pathogens Among Children With Acute Diarrhea in Zanzibar

Maria Eva Andersson, Kristina Elfving, Deler Shakely, Staffan Nilsson, Mwinyi Msellem, Birger Trollfors, Andreas Mårtensson, Anders Björkman, Magnus Lindh  |  Published
Clinical infectious diseases: an official publication of the Infectious Diseases Society of America

Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar - Aetiologies, Antibiotic Treatment and Outcome

Kristina Elfving, Deler Shakely, Maria Andersson, Kimberly Baltzell, Abdullah S Ali, Marc Bachelard, Kerstin I Falk, Annika Ljung, Mwinyi I Msellem, Rahila S Omar, Philippe Parola, Weiping Xu, Max Petzold, Birger Trollfors, Anders Björkman, Magnus Lindh, Andreas Mårtensson  |  Published
PLoS One

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