title: Deconstructing "malaria": West Africa as the next front for dengue fever surveillance and control.
abstract: Presumptive treatment of febrile illness patients for malaria remains the norm in endemic areas of West Africa, and "malaria" remains the top source of health facility outpatient visits in many West African nations. Many other febrile illnesses, including bacterial, viral, and fungal infections, share a similar symptomatology as malaria and are routinely misdiagnosed as such; yet growing evidence suggests that much of the burden of febrile illness is often not attributable to malaria. Dengue fever is one of several viral diseases with symptoms similar to malaria, and the combination of rapid globalization, the long-standing presence of Aedes mosquitoes, case reports from travelers, and recent seroprevalence surveys all implicate West Africa as an emerging front for dengue surveillance and control. This paper integrates recent vector ecology, public health, and clinical medicine literature about dengue in West Africa across community, regional, and global geographic scales. We present a holistic argument for greater attention to dengue fever surveillance in West Africa and renew the call for improving differential diagnosis of febrile illness patients in the region.
authors.affiliation: Department of Geography and Regional Studies, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA. Electronic address: stoler@miami.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Stoler
authors.affiliation: Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA. Electronic address: rawan_dashti@hotmail.com.
authors.forename: Rawan
authors.initials: R
authors.lastname: Al Dashti
authors.affiliation: Department of Epidemiology and Disease Control, University of Ghana, Legon, Ghana. Electronic address: fanto@ug.edu.gh.
authors.forename: Francis
authors.initials: F
authors.lastname: Anto
authors.affiliation: Department of Biological, Environmental & Occupational Health Sciences, University of Ghana, Legon, Ghana. Electronic address: jfobil@ug.edu.gh.
authors.forename: Julius N
authors.initials: JN
authors.lastname: Fobil
authors.affiliation: Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana. Electronic address: gawandare@ug.edu.gh.
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Awandare
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods*; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000517:prevention & control*; D003715:Dengue / Q000453:epidemiology* / Q000517:prevention & control*; D062665:Epidemiological Monitoring; D006801:Humans
keywords: Africa; Dengue; Febrile illness; Ghana; Malaria