The short answer
A malaria test, a rapid test or a blood film, should be done before any antimalarial, and its result is reliable when done properly: a negative test usually means the fever is something else. A typhoid result is different. The Widal test, which many laboratories run alongside the malaria test, is often positive in people who do not have typhoid, including people with malaria, so a single Widal result cannot confirm typhoid. Typhoid is confirmed by a blood culture taken before antibiotics. You do not need a malaria and typhoid test for every fever: you need a doctor to decide which test answers the question.
See a doctor by videoMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
The malaria test
Nigeria's national malaria guidelines and the WHO both say every suspected case of malaria should be confirmed with a test before treatment. A rapid diagnostic test (RDT) gives an answer in minutes from a finger prick; microscopy of a blood film, read by a trained laboratory scientist, also counts the parasites. Treating without a test means people with other illnesses take antimalarials they do not need, while the real cause of the fever goes untreated.
Why the Widal test misleads
The Widal test looks for antibodies, not for the typhoid germ itself. Antibodies can be raised by a past typhoid infection, a typhoid vaccine, or other infections, and a study at the University of Benin Teaching Hospital found that a single Widal test was not a valid way to diagnose typhoid, and that heavier malaria infections were linked with positive Widal results. This is how many people with malaria, or a virus, are told they have "malaria and typhoid" and given antibiotics they do not need.
How typhoid is actually confirmed
A doctor suspects typhoid from the story and the examination, then confirms it:
- A fever that climbs over several days, with headache, tummy pain, weakness and loss of appetite
- A blood culture, taken before any antibiotic, which grows the germ and shows which antibiotics will work
- Sometimes a stool culture
- Treatment chosen by the doctor, because typhoid germs resistant to common antibiotics are increasing
Go to a hospital now
Whatever the test result, go to an emergency department straight away for:
- Confusion, a fit, or being very drowsy
- Difficulty breathing
- Yellow eyes, or dark or cola-coloured urine
- Severe tummy pain, vomiting blood or black stools
- Being unable to keep any fluid down
- A child under five with fever who cannot drink, vomits everything or is very sleepy
Common questions
My result says malaria and typhoid. Do I need treatment for both?
Treat the malaria if the malaria test is positive. A positive Widal on its own does not prove typhoid, so ask a doctor to review the result before you take antibiotics, and ask for a blood culture if typhoid is still suspected.
My malaria test was negative but I still have fever. Should I take antimalarials anyway?
No. A negative test done properly usually means it is not malaria. A doctor should look for another cause, such as a urine, chest or throat infection, typhoid, or a virus. If you stay unwell, the test can be repeated.
Which is more dangerous, malaria or typhoid?
Both can kill. Malaria can become severe within a day, especially in children under five and in pregnancy. Typhoid builds over days and can cause bleeding or a hole in the bowel if untreated. That is why the right test matters more than guessing which it is.
Can a doctor review my test results by video?
Yes. A doctor can go through your results on a call, tell you whether they make sense with your symptoms, and arrange a blood culture or another test where it is needed. Anyone with a danger sign should go to a hospital instead.
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Sources and further reading
The guidelines and patient information this page is checked against. Care in Nigeria follows the same evidence; what differs is the price and where it is done.
- National Guidelines for the Diagnosis and Treatment of Malaria, 4th edition (2020). National Malaria Elimination Programme, Federal Ministry of Health, Nigeria, 2020. Official publication.
- WHO guidelines for malaria. World Health Organization. Clinical guideline.
- Typhoid fever in a tertiary hospital in Nigeria: another look at the Widal agglutination test as a preferred option for diagnosis. Enabulele O, Awunor SN, Nigerian Medical Journal 57(3):145-149, 2016. Peer-reviewed.
- Typhoid. World Health Organization. Fact sheet.
Links last checked 24 October 2026.
Medical disclaimer: This guide is general information and does not replace advice from your own doctor. Where your centre's instructions differ from this guide, follow theirs.