Malaria among febrile patients suspected of Yellow fever during an outbreak in Ghana

Introduction Between October 2021 and February 2022, there was an outbreak of Yellow fever that spread within several districts in the northern part of Ghana. Febrile illnesses such as Yellow fever are often misdiagnosed as malaria and vice versa, which delays appropriate management and treatment. Hence, the true burden of Yellow fever and malaria are mostly underestimated. This study investigated the epidemiology of malaria in febrile patients suspected of Yellow fever in and around the epicenter of a Yellow fever outbreak in Ghana. Methods The study was a cross-sectional study conducted in two outbreak sites (Wenchi and Damongo) and two non-outbreak sites (Kumbungu and Tamale). A total of 498 febrile patients from healthcare facilities were recruited in the rainy and dry seasons. A structured questionnaire was administered to collect patients’ demographic information. Venous blood was collected from consented study participants for malaria parasite detection via microscopy and PCR. Total RNA was extracted from serum samples for the detection of yellow fever virus using Reverse Transcriptase PCR. Results None of the patients tested positive for Yellow fever virus. Out of the 498 participants tested for plasmodium parasites, 98 (19.7%) were microscopy positive while 92 (29.7%) were PCR positive. Plasmodium prevalence via microscopy was significantly higher in the dry season, 42 (18.67%) compared to the rainy season, 12 (4.4%) ( P  < 0.001). However, the difference in malaria prevalence via PCR in the rainy and dry seasons was not significant ( P  > 0.05). Kumbungu had the highest parasite prevalence by PCR during the dry (78.38%) and rainy (27.18%) seasons. Higher Plasmodium falciparum prevalence was observed using PCR compared to microscopy across all age groups. The age groups with the highest prevalence of P. falciparum were under five years (34.69%) and 5 to 9 years (35.56%). The differences in P. falciparum prevalence across the age groups were significant ( P  < 0.05). Conclusion High malaria prevalence was found in the study sites, affecting preschool and the school-aged children the most. Although Yellow fever was not detected, its overlap with malaria in Ghana, suggests the importance of enhancing surveillance for both diseases to better prevent and control