Doctors Revision

IMCI · Age: 2 months - 5 years

Fever - No Malaria

Classification for a child presenting with fever (or history/hot/temp ≥37.5°C) who has a negative malaria test OR malaria test was not done but no obvious cause of fever identified, AND no signs of Very Severe Febrile Disease. Requires management of fever and identification/treatment of any other bacterial cause.

View images for Fever - No Malaria (Google Images, opens in a new tab)
On this page

Care priority and warning signs

Care priority

Routine Management / Treat underlying cause if identified

Red flags

  • Development of any danger sign or stiff neck.
  • Fever persisting > 3 days without improvement.
  • Fever present every day for more than 7 days.
  • Fever present for 14 days or more (check for TB).

Assessment

  • Ask: Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
  • Confirm absence of General Danger Signs.
  • Confirm absence of Stiff Neck.
  • Perform Malaria Test (RDT or Microscopy) - Result is NEGATIVE OR test not done.
  • Look for other causes of fever (e.g., signs of pneumonia, ear infection, UTI symptoms, skin infection, throat infection).

Classification

  • Fever present AND Malaria test NEGATIVE (or not done/available) AND Other cause of fever PRESENT -> FEVER - NO MALARIA (Treat the identified cause)
  • Fever present AND Malaria test NEGATIVE (or not done/available) AND No other cause of fever identified -> FEVER - NO MALARIA (Likely Viral)

Key features

  • Fever (current or recent history).
  • Malaria test is negative (or not done but malaria unlikely/ruled out clinically where appropriate).
  • Absence of any general danger sign or stiff neck.
  • Need to search for and treat other potential causes of fever.
  • If no cause found, likely viral, manage symptomatically.

Management

Non-pharmacological management

  • Advise adequate fluid intake.
  • Continue feeding.
  • Advise tepid sponging for comfort if high fever (optional).

Pharmacological treatment

  • Give one dose of Paracetamol (10-15 mg/kg) in the clinic if high fever (≥38.5°C axillary) - see dosage on page 15.
  • If an identified bacterial cause of fever is present (e.g., Pneumonia, Acute Ear Infection, Dysentery): Give appropriate antibiotic treatment for that condition (refer to relevant sections/pages for drug, dose, duration - e.g., Amoxicillin for Pneumonia/AOM, Ciprofloxacin for Dysentery).
  • If fever is present every day for > 7 days, refer for further assessment.
  • If fever is present for > 14 days, check for TB (assess symptoms, contact history - see page 9).

Follow-up

  • Follow-up in 3 days IF fever persists.
  • At follow-up: Reassess child fully (check danger signs, stiff neck, source of fever). If danger signs/stiff neck, treat as Very Severe Febrile Disease and refer. If fever persists without source, reassess carefully, consider referral if >7 days total or child unwell. If another cause identified, treat. If improving, reassure.
  • Advise mother when to return immediately.

Counselling points

  • If bacterial cause identified: Explain diagnosis and need for antibiotic. Teach how to give antibiotic correctly.
  • If no bacterial cause identified: Explain likely viral cause, reassure that antibiotics are not needed. Explain that fever may last a few days.
  • Teach how to give Paracetamol for high fever at home (correct dose, frequency max every 6 hours).
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs, develops stiff neck, becomes sicker, fever persists > 3 days without improving at all, or develops localizing signs.
  • Advise to return in 3 days if fever persists.

Differential diagnosis

  • Viral URTI / LRTI (Flu, adenovirus etc.)
  • Pneumonia
  • Acute Otitis Media
  • Urinary Tract Infection (UTI)
  • Tonsillitis/Pharyngitis (Bacterial or Viral)
  • Skin and soft tissue infection (abscess, cellulitis)
  • Gastroenteritis (may have fever)
  • Typhoid fever
  • Tuberculosis (if prolonged fever)
  • Other less common infections (e.g., Brucellosis, Rickettsial)
  • Non-infectious causes (rare in this context - e.g., Kawasaki disease)

Complications

  • Febrile convulsions
  • Dehydration
  • Complications related to the underlying cause of fever (e.g., mastoiditis from ear infection, pyelonephritis from UTI).

Prevention

  • Immunizations.
  • Handwashing, hygiene.
  • Good nutrition.
  • Malaria prevention (reduces malaria as cause, helps focus on other causes).
  • Prompt care seeking.

References

IMCI Chart Booklet - Page 4, Page 9 (TB), Page 15 (Paracetamol), Page 23 (Follow-up), Page 30 (Return signs)

For learning and professional reference. Use current local guidance and clinical judgement.

Browse imci entries
Scroll to Top