Unmasking non-malarial mosquito-borne infections among febrile children in malaria-endemic regions of western Kenya.

Almost half of under-five children in health facilities are febrile in sub-Saharan Africa. The non-specific clinical symptoms coupled with; limited diagnostics capacities, overlapping endemicity and the surveillance gaps complicates accurate cause identification of an acute febrile illnesses in resource limited settings. This challenge leads to misdiagnosis, overtreatment, and delays in appropriate management, increasing morbidity and mortality. Health systems are often overloaded, with providers attributing fevers to the most common pathogen, while other emerging infections are the cause. This study unpacked the febrile illness by testing for dengue fever in parallel to malaria. Febrile ill children below 5 years seeking health services public health facilities in Busia and Kisumu Counties were screened using an approved malaria and dengue fever rapid test kits at the outpatient department. Those who screened positive were recruited into the study. A total of 1004 children were screened, 380 met the recruitment criteria. 215 (21.4%) tested positive for P. falciparum alone, 90 (8.9%) tested positive for dengue fever alone while 75 (7.5%) had co-infections. Busia had the highest P. falciparum-only infection (23.4%) while Kisumu had the highest dengue-only infections (12.6%). Dengue fever is a re-emerging neglected tropical, climate change driven disease in malaria endemic regions. Other than creating awareness to build capacity for diagnosis, this study unmasked and confirmed dengue as a major contributor to the non malarial febrile illnesses among children. There is need to revise the screening algorithm for febrile patients to improve arboviral surveillance.