Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study
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Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study. / Rautman, Lydia Helen; Maiga-Ascofaré, Oumou; Eibach, Daniel; Hogan, Benedikt; Dekker, Denise; Jaeger, Anna; Akenten, Charity Wiafe; Owusu-Dabo, Ellis; Boateng, Felix Osei; Hanson, Henry; Boahen, Kennedy Gyau; Sarpong, Nimako; Adu-Sarkodie, Yaw; Kreuels, Benno; May, Jürgen; Krumkamp, Ralf.
In: TROP MED INT HEALTH, Vol. 29, No. 3, 03.2024, p. 206-213.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study
AU - Rautman, Lydia Helen
AU - Maiga-Ascofaré, Oumou
AU - Eibach, Daniel
AU - Hogan, Benedikt
AU - Dekker, Denise
AU - Jaeger, Anna
AU - Akenten, Charity Wiafe
AU - Owusu-Dabo, Ellis
AU - Boateng, Felix Osei
AU - Hanson, Henry
AU - Boahen, Kennedy Gyau
AU - Sarpong, Nimako
AU - Adu-Sarkodie, Yaw
AU - Kreuels, Benno
AU - May, Jürgen
AU - Krumkamp, Ralf
N1 - © 2023 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
PY - 2024/3
Y1 - 2024/3
N2 - BACKGROUND: Healthcare 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.METHODS: Febrile 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.RESULTS: There 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.CONCLUSIONS: Suspected 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.
AB - BACKGROUND: Healthcare 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.METHODS: Febrile 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.RESULTS: There 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.CONCLUSIONS: Suspected 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.
U2 - 10.1111/tmi.13962
DO - 10.1111/tmi.13962
M3 - SCORING: Journal article
C2 - 38093593
VL - 29
SP - 206
EP - 213
JO - TROP MED INT HEALTH
JF - TROP MED INT HEALTH
SN - 1360-2276
IS - 3
ER -
