Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia

Techalew Shimelis; Susana Vaz Nery; Birkneh Tilahun Tadesse; Adam W Bartlett; Fitsum W/Gebriel Belay; Gill Schierhout; Sabine Dittrich; John A Crump; John M Kaldor

doi:10.1186/s12879-022-07424-0

Clinical management and outcomes of acute febrile illness in children attending a tertiary hospital in southern Ethiopia

BMC Infect Dis. 2022 May 4;22(1):434. doi: 10.1186/s12879-022-07424-0.

Authors

Affiliations

¹ Kirby Institute, University of New South Wales, Sydney, Australia. techalew03@yahoo.com.
² College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia. techalew03@yahoo.com.
³ Kirby Institute, University of New South Wales, Sydney, Australia.
⁴ College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
⁵ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁶ Foundation for Innovative New Diagnostics, Geneva, Switzerland.
⁷ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁸ Centre for International Health, University of Otago, Dunedin, New Zealand.

Abstract

Background: The management of febrile illnesses is challenging in settings where diagnostic laboratory facilities are limited, and there are few published longitudinal data on children presenting with fever in such settings. We have previously conducted the first comprehensive study of infectious aetiologies of febrile children presenting to a tertiary care facility in Ethiopia. We now report on clinicians' prescribing adherence with guidelines and outcomes of management in this cohort.

Methods: We consecutively enrolled febrile children aged 2 months and under 13 years, who were then managed by clinicians based on presentation and available laboratory and radiologic findings on day of enrolment. We prospectively collected outcome data on days 7 and 14, and retrospectively evaluated prescribing adherence with national clinical management guidelines.

Results: Of 433 children enrolled, the most common presenting syndromes were pneumonia and acute diarrhoea, diagnosed in 177 (40.9%) and 82 (18.9%), respectively. Antibacterial agents were prescribed to 360 (84.7%) of 425 children, including 36 (34.0%) of 106 children without an initial indication for antibacterials according to guidelines. Antimalarial drugs were prescribed to 47 (11.1%) of 425 children, including 30 (7.3%) of 411 children with negative malaria microscopy. Fever had resolved in 357 (89.7%) of 398 children assessed at day 7, and in-hospital death within 7 days occurred in 9 (5.9%) of 153 admitted patients. Among children with pneumonia, independent predictors of persisting fever or death by 7 days were young age and underweight for age. Antibacterial prescribing in the absence of a guideline-specified indication (overprescribing) was more likely among infants and those without tachypnea, while overprescribing antimalarials was associated with older age, anaemia, absence of cough, and higher fevers.

Conclusion: Our study underscores the need for improving diagnostic support to properly guide management decisions and enhance adherence by clinicians to treatment guidelines.

Keywords: Antibacterial; Antimalarial; Clinical management; Fever; Outcome; Overprescribing; Pneumonia.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Antimalarials* / therapeutic use
Child
Ethiopia / epidemiology
Fever* / drug therapy
Fever* / etiology
Hospital Mortality
Humans
Infant
Retrospective Studies
Tertiary Care Centers

Substances

Anti-Bacterial Agents
Antimalarials