MALARIA AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AMONG MALE EMPLOYEES OF A SUGAR ESTATE IN MALAWI

In sub-saharan Africa, where malaria is endemic and diagnostic and lab oratory services are limited, fever is generally presumed to be due to malaria; however, the proportion of fevers actually related to malari a is unknown in most places. This study was conducted to determine the relationship between fever, malaria parasitaemia and human immunodefi ciency virus (HIV) infection. Between February and April 1994, 643 con senting adult male workers of the Sugar Corporation of Malawi (SUCOMA) in Nchalo, Chikwawa District, Malawi were enrolled in a cross-section al study. Participants underwent routine physical examinations and dat a were collected on age, axillary temperature, and history of fever or other illness in the 2 weeks before enrolment. Patients with axillary temperature greater than or equal to 37.5 degrees C were considered t o be febrile. Blood was collected and thick blood films were prepared and examined for the presence of malaria parasites. HIV testing was do ne using the Wellcozyme(R) enzyme-linked immunosorbent assay. Complete information was obtained from 605 subjects (94%), of whom 248 (41%) r eported a history of fever (only 15% of the fever reporters were paras itaemic), 139 (23%) were HIV positive, and 131 (22%) received an antim alarial drug. HIV infection was significantly associated with fever bu t not with parasitaemia. Fever reporters and non-fever reporters were of similar age (means 32.8 and 33.1 years, respectively). These data s uggest that in this population there was both high HIV seroprevalence and gross overestimation of fever as malaria. High HIV prevalence make s it necessary to re-examine the common practice in Malawi of treating all fever among adults as malaria.