Factors associated with treatment type of non-malarial febrile illnesses in under-fives at Kenyatta National Hospital in Nairobi, Kenya

Abstract

Background Non-malarial febrile illnesses comprise of almost half of all fever presenting morbidities, among under-five children in sub-Saharan Africa. Studies have reported cases of prescription of antimalarial medications to these febrile under-fives who were negative for malaria. The treatment of these children with antimalarial medications increases incidences of antimalarial drug resistance as well as further morbidities and mortalities, due to failure to treat the actual underlying causes of fever. Aim To identify clinical and demographic factors associated with treatment type (malarial/non-malarial) of non-malarial febrile illnesses (NMFI) in children aged ≤5 at the Kenyatta National Hospital in Nairobi, Kenya. Methods A positivist epistemological approach, cross sectional descriptive study design was used. A structured questionnaire was used on a sample of 341 medical records of children aged ≤5 years to extract data on clinical examinations (recorded as yes or no), diagnostic test results, and demographic data on the child’s sex and age. Descriptive and inferential analysis was applied to the data. Results Prescription of antimalarial drugs despite negative microscopy results was found in 44 (12.9%) of the children, with mortality reported in 48 (14.1%). Assessment of respiratory distress was 0.13 (0.03,0.58) times associated with less likelihood of prescribing an antimalarial in those with a negative microscopy. A male patient was 0.21 (0.05,0.89) times less likely to receive an intravenous antimalarial after a negative microscopy. Patients aged ˂1 with a negative microscopy result were more likely to receive an antimalarial than older children. Conclusion There is a need to eliminate incorrect treatment of NMFI with antimalarial medication, while ensuring correct diagnosis and treatment of the specific illness occurs. This requires strengthening and adherence to diagnostic and treatment guidelines of febrile illnesses in under-fives, consequently reducing morbidities and mortalities associated with inadequate management of NMFIs.

A survey of mosquito-borne and insect-specific viruses in hospitals and livestock markets in western Kenya

“…In Kenya, two acute cases of Sindbis virus were detected by inoculation on Vero cell lines and RT-PCR in febrile patients from Mfangano islands of Lake Victoria [ 47 ], and seroprevalence studies in other Kenyan regions have shown exposure in local populations [ 48 , 49 ]. Clinical cases may be masked by other febrile illnesses, such as malaria in Kenya, and may therefore go unnoticed due to lack of awareness and inadequate diagnostic capabilities in health institutions [ 12 , 50 , 51 ].…”

Past eight-year malaria data in Gedeo zone, southern Ethiopia: trend, reporting-quality, spatiotemporal distribution, and association with socio-demographic and meteorological variables

“…If laboratory performance percent confirmed declines it means; laboratory performance was decreasing over the years or something causing febrile illness in the area is increasing. Misdiagnosis and treating malaria clinically based only on fever with antimalarial drugs, which is still in remote settings, may contribute to the rapid emergence of antimalarial drug resistance [ 38 , 39 ].…”

Eight-year Retrospective Analysis of Malaria Trends in Gedeo Zone, South Ethiopia (2012-2019)

“…If laboratory performance percent con rmed declines it means; laboratory performance was decreasing over the years or something causing febrile illness in the area is increasing. Misdiagnosis and incorrect treatment of such non-malarial febrile illnesses with antimalarial drugs is possibly to contribute to rapid emergence of antimalarial drug resistance [21,22] in the study area.…”