Fever in Africa and WHO recommendation

• Published in: The Lancet (British edition) Vol. 350; no. 9090; p. 1550
• Main Authors: Dunyo, Samuel K, Koram, Kwadwo A, Nkrumah, Francis K
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 22.11.1997; Elsevier Limited
• Subjects: Child; Child, Preschool; Fever - diagnosis; Ghana; Humans; Infant; Malaria - diagnosis; Reproducibility of Results; Thermosensing; Ghana
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(05)63981-5

I was disappointed that Ellen Einterz and Myra Bates do not acknowledge the local traditional and cultural meanings of the symptom "being hot" in Africa. Their study was conducted in Northern Cameroon, where most people use local, traditional health care delivery, and the words patients use to describe symptoms and diseases must be understood within that cultural context. When a patient says that he or she has fever or heat inside them, it can be due to various causes and can manifest itself in a range of symptoms, one of which may be a rise in bodily temperature. Einterz and Bates conclude that "a patient's or carer's report of fever is not reliable." Their work usefully highlights the proportion of patients who said they are hot and who actually had an increase in temperature. But the symptomatology of the patients who were incorrect should not be derided. If a patient complains that they have fever, then appropriate questions and instruments should be used to assess and understand the symptom, rather than just depending on the explanation from western medicine of a rise in temperature. The same word can have different meanings between lay and professional circles, as well as between different cultures. The question in Africa is not only do patients know when they are hot, but also do western-trained doctors know what patients mean when they say they are hot?