Syndromic presentation by patients with malaria and respiratory symptoms in a malaria-endemic urban-and-peri-urban setting

In malaria-endemic areas, adults frequently present with symptoms resembling upper respiratory infections such as fever, cough, and sore throat, complicating clinical diagnosis. This study aimed to determine the prevalence of malaria among adults presenting with upper respiratory symptoms in an urban and peri-urban Ugandan setting, identify predictive symptom patterns, and assess a simple symptom-based score for malaria risk. The analysis was derived from screening data collected as part of an ongoing malaria treatment study. Among 332 adults evaluated at six outpatient clinics, malaria was confirmed in 16.0% by both rapid diagnostic test and microscopy. Fever and cough were the most frequent symptoms and the strongest independent predictors of malaria. Malaria positivity increased with the number of symptoms; from 0.8% among those with one symptom to 100% among those with four. Combinations that included fever, particularly fever with cough or sore throat, yielded the highest malaria positivity. A four-point symptom score (fever, cough, nasal symptoms, sore throat) showed 98.1% sensitivity and 47.3% specificity at a threshold of two or more symptoms. Incorporating this score into triage could optimize malaria testing in resource-limited outpatient settings.