Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Abstract

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections

“…Overuse of antibiotic therapy is an important clinical problem, which increases the rates of microbial resistance ( 41 , 42 ). New guidelines and studies continue to be developed to standardize the symptomatic and causal treatment of respiratory tract infections ( 6 , 12 – 15 , 43 , 44 ). Data on the use of a delayed antibiotic prescribing strategy for respiratory tract infections have shown that it significantly reduces the frequency of antibiotic use, with no negative effects in terms of an increased number of complications being associated with this treatment approach ( 45 ).…”

“…It also ensures the effective elimination of pathogenic microbes and controls the diseases that they cause (4,10,11). Due to the widespread abuse and misuse of antibiotics, many global and local guidelines for their proper use have been developed (1,5,6,(12)(13)(14)(15). The rational use of antibiotics should lead to the rapid and complete elimination of pathogenic bacteria, with minimal adverse effects.…”

“…The rational use of antibiotics should lead to the rapid and complete elimination of pathogenic bacteria, with minimal adverse effects. Therefore, these agents must be used carefully, at adequate doses, and without treatment discontinuation before the end of the entire course of therapy ( 5 , 13 , 15 ). Preventive antimicrobial therapy in unjustified cases should be avoided, and the latest generation drugs should be used only for the most severe infections.…”

The Description of Knowledge and Attitudes of Parents in Performing First Aid for Hyperthermia in Preschool-Age Children

“…Based on the theory, an accurate way of measuring body temperature is to use a thermometer by placing it in several parts of the body including the armpits, mouth, and rectum (El-Radhi et al, 2019;Potter et al, 2015). However, the safest and most accurate place for measurement is the armpit (Green et al, 2021). From these results, it can be concluded that most respondents already know and understand the most accurate way to measure body temperature, namely with a thermometer placed in the armpit as the safest place to measure temperature, but there are still respondents who measure by touching the forehead due to one of them from lack of information.…”

A review of acute febrile illness

“…Acute febrile illness (AFI) is defined as a sudden rise in the body temperature above 38 • Celsius (100.4 degrees Fahrenheit) for 2-14 days duration without any specific etiology. 1 AFI is a significant cause of morbidity and mortality in developing countries. AFI is India's most common cause of hospitalization.…”