title: Season, fever prevalence and pyrogenic threshold for malaria disease definition in an endemic area of Mali.
abstract: BACKGROUND
  Modelling malaria parasitaemia as function of fever has been proposed as best alternative to estimate the attributable fraction of malaria fever and the sensitivity and specificity of different case definitions of malaria disease.
  
  
  OBJECTIVE
  To determine the prevalence of fever and its relation to malaria parasitaemia and to establish a pyrogenic threshold for malaria disease in the area.
  
  
  METHODS
  We conducted two cross-sectional surveys in children of 6 months to 9 years of age (2434 during the rainy season of 1993 and 2353 during the dry season of 1994) randomly selected from 21 areas of Bandiagara district, Mali.
  
  
  RESULTS
  The relationship between fever and Plasmodium falciparum parasitaemia depends strongly on the season, thus affecting the malaria-attributable fraction of fever cases and the sensitivity and specificity of malaria case definitions. The overall proportion of fever attributable to malaria parasitaemia was 33.6% during the rainy season and 23.3% during the dry season, with the highest proportion occurring among the youngest children. The cut-off value, where the sensitivity curve crosses the specificity curve, was around 3200 pf/microl for all age categories during the rainy season and 200 pf/microl during the dry season.
  
  
  CONCLUSIONS
  Malaria remains a main cause of fever in this area of Mali. The pyrogenic threshold of parasitaemia depends strongly on the season, and different cut-off levels of parasitaemia should be used during the two seasons to define malaria cases in this area.
authors.affiliation: Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-stomatology, University of Bamako, Bamako, Mali. adicko@mrtcbko.org
authors.forename: Alassane
authors.initials: A
authors.lastname: Dicko
authors.forename: Carsten
authors.initials: C
authors.lastname: Mantel
authors.forename: Boureima
authors.initials: B
authors.lastname: Kouriba
authors.forename: Issaka
authors.initials: I
authors.lastname: Sagara
authors.forename: Mahamadou A
authors.initials: MA
authors.lastname: Thera
authors.forename: Seydou
authors.initials: S
authors.lastname: Doumbia
authors.forename: Mouctar
authors.initials: M
authors.lastname: Diallo
authors.forename: Belco
authors.initials: B
authors.lastname: Poudiougou
authors.forename: Mahamadou
authors.initials: M
authors.lastname: Diakite
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
mesh_terms: D017677:Age Distribution; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D005334:Fever / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008302:Mali / Q000453:epidemiology; D018512:Parasitemia / Q000150:complications / Q000453:epidemiology*; D010963:Plasmodium falciparum / Q000302:isolation & purification; D015995:Prevalence; D012621:Seasons