A study from Tanzania highlights the diverse etiology of AFI. Of 870 hospital admissions, 528 (60.7%) patients were clinically diagnosed with malaria, but only 14 (1.6%) actually had malaria parasites upon subsequent blood analysis. Ten different kinds of infections, including bloodstream infections, bacterial and fungal infections, and arboviruses, were all presumptively diagnosed as malaria based on clinical symptoms . But this study was conducted in Moshi, a city of roughly 144,000, which may not be representative of the local disease ecology of large, tropical SSA urban agglomerations like Luanda, Dar es Salaam, Abidjan, Nairobi, or Accra, much less emerging megacities like Lagos or Kinshasa-Brazzaville. We are just beginning to realize how little we know about communicable disease epidemiology in SSA.