Management of febrile illness in rural Guinea over a seven-year period: A retrospective study

Kourouma, Karifa; Grovogui, Fassou Mathias; Délamou, Alexandre; Chérif, Mahamoud Sama; Ingelbeen, Brecht; Béavogui, Abdoul Habib; Griensven, Johan van; Bottieau, Emmanuel

doi:10.1371/journal.pgph.0001133

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…In‐hospital medication prescription was comparable to other studies [18, 19]. Over‐prescription results in drug wastage, higher expenses, potential exposure to drug toxicity, neglect of the true source of fever and brings a risk of antimicrobial resistance [7].…”

Section: Discussionsupporting

confidence: 56%

Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana—A longitudinal hospital study

Rautman,

Maiga‐Ascofaré,

Eibach

et al. 2023

Tropical Med Int Health

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BackgroundHealthcare resources are often limited in areas of sub‐Saharan Africa. This makes accurate and timely diagnoses challenging and delays treatment of childhood febrile illness. We explored longitudinal characteristics related to symptoms, diagnosis and treatment of hospitalised febrile children in a rural area of Ghana highly endemic for malaria.MethodsFebrile children under 15 years, admitted to the study hospital paediatric ward, were recruited to the study and clinical data were collected throughout hospitalisation. Descriptive statistics were reported for all cases; for longitudinal analyses, a subset of visits with limited missing data was used.ResultsThere were 801 hospitalised children included in longitudinal analyses. Malaria (n = 581, 73%) and sepsis (n = 373, 47%) were the most prevalent suspected diagnoses on admission. One‐third of malaria suspected diagnoses (n = 192, 33%) were changed on the discharge diagnosis, compared to 84% (n = 315) of sepsis suspected diagnoses. Among malaria‐only discharge diagnoses, 98% (n/N = 202/207) received an antimalarial and 33% (n/N = 69/207) an antibiotic; among discharge diagnoses without malaria, 28% (n/N = 108/389) received an antimalarial and 83% (n/N = 324/389) an antibiotic.ConclusionsSuspected diagnoses were largely based on clinical presentation and were frequently changed; changed diagnoses were associated with lingering symptoms, underscoring the need for faster and more accurate diagnostics. Medications were over‐prescribed regardless of diagnosis stability, possibly because of a lack of confidence in suspected diagnoses. Thus, better diagnostic tools are needed for childhood febrile illnesses to enhance the accuracy of and confidence in diagnoses, and to cut down unjustified medication use, reducing the risk of antimicrobial and malaria resistance.

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Section: Discussionsupporting

confidence: 56%

Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana—A longitudinal hospital study

Rautman,

Maiga‐Ascofaré,

Eibach

et al. 2023

Tropical Med Int Health

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Modeling pediatric antibiotic use in an area of declining malaria prevalence

Rautman,

Eibach,

Boateng

et al. 2024

Sci Rep

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In malaria-endemic areas of Sub-Saharan Africa, overlap of clinical symptoms between malarial and non-malarial febrile illnesses can lead to empiric use of antibiotics among children. Our study aimed to illustrate the potential impact of decreasing malaria prevalence from malaria control efforts on antibiotic use. We constructed a probabilistic decision tree model representing antibiotic prescription in febrile children < 5 years. This model was used to predict change in absolute antibiotic use compared to baseline under levels of decreasing malaria prevalence. Model parameters were based on data from a hospital study in Ghana and validated via literature review. The baseline prevalence of malaria diagnoses was 52% among all hospitalized children. For our main results, we reported outcomes for a scenario representing a 50% decrease in malaria prevalence. Compared to baseline, absolute antibiotic prescription decreased from a baseline of 639 doses (95% CI 574–694) to 575 (95% CI 502–638). This reflected a 10% (95% CI 7%–13%) decrease in absolute antibiotic use. Our findings demonstrate that effective malaria control can reduce pediatric antibiotic use. However, until substantial progress is made in developing accurate diagnostics for non-malarial febrile illnesses, further reductions in antibiotic use will remain a challenge.

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Management of febrile illness in rural Guinea over a seven-year period: A retrospective study

Cited by 2 publications

References 30 publications

Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana—A longitudinal hospital study

Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana—A longitudinal hospital study

Modeling pediatric antibiotic use in an area of declining malaria prevalence

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