Differences in diagnosis, management, and outcomes of acute febrile illness by health facility level in southern Ethiopia

Abstract

We assessed the diagnosis, management and outcomes of acute febrile illness in a cohort of febrile children aged under 5 years presenting at one urban and two rural health centres and one tertiary hospital between 11 August 2019 and 01 November 2019. Pneumonia was diagnosed in 104 (30.8%) of 338 children at health centres and 128 (65.0%) of 197 at the hospital (p < 0.001). Malaria was detected in 33 (24.3%) of 136 children at the urban health centre, and in 55 (55.6%) of 99 and 7 (7.4%) of 95 children at the rural health centres compared to 11 (11.6%) of 95 at the hospital. Antibacterials were prescribed to 20 (11.5%) of 174 children without guidelines-specified indications (overprescribing) at health centres and in 7 (33.3%) of 21 children at the hospital (p = 0.013). Antimalarials were overprescribed to 13 (7.0%) of 185 children with negative malaria microscopy at the hospital. The fever resolved by day 7 in 326 (99.7%) of 327 children at health centres compared to 177 (93.2%) of 190 at the hospital (p < 0.001). These results suggest that additional guidance to health workers is needed to optimise the use of antimicrobials across all levels of health facilities.

Detection of dengue virus infection in children presenting with fever in Hawassa, southern Ethiopia

“…The reported low proportion of dengue at the study hospital, which is located close to Lake Hawassa where mosquito-borne infections are expected to be common, may be explained by the hospital's regional referral function, which draws severe cases such as severe pneumonia, as shown in our initial report 21 . It is also possible that caregivers were more likely to seek care from lower-health facilities than the hospital when they suspected malaria and similar acute febrile illness, as observed in our recent report 30 . As a result, it would likely be more representative to expand the scope of such studies to include lower-level health facilities to capture mild acute febrile illnesses.…”