Malaria among febrile patients during a yellow fever outbreak in Ghana: a cross-sectional study

INTRODUCTION: Between October 2021 and February 2022, there was an outbreak of yellow fever viral disease that spread within several districts in the northern part of Ghana. Malaria is the leading cause of death in most sub-Saharan countries including Ghana. It is important that surveillance is focused on malaria among febrile patients during a yellow fever outbreak in Ghana. This study investigated infection with malaria among febrile patients during a yellow fever outbreak in Ghana. METHODS: The study was a cross-sectional study conducted in two yellow fever 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 nested Polymerase Chain Reaction (PCR). Total RNA was extracted from serum samples for the detection of yellow fever virus using Reverse Transcription-PCR (RT-PCR). RESULTS: None of the patients tested positive for yellow fever virus by RT-PCR. Out of a total of 498 febrile participants, 129/498 (25.90%) tested positive by PCR for P. falciparum parasites and 378 were examined for malaria microscopy with 54/378 (14.29%) testing positive to P. falciparum parasite detection. While there were 54/410 (13.17%) cases of P. falciparum infections via microscopy in the rainy season there was no positive infection in the dry season 0/88 (0%). However, the difference in malaria prevalence via PCR in the rainy and dry seasons was not significant (P > 0.05). CONCLUSION: Nucleic acid for yellow fever was not detected among all the febrile patients. High malaria prevalence was found in participants in the study sites, affecting preschool and the school-aged children the most. This suggests an underscoring urgent need for malaria interventions to mitigate high transmission within communities especially among school-based populations.