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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Beyond malaria - Causes of fever in outpatient Tanzanian children
New England Journal of Medicine, Volume 370, No. 9, Year 2014
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Description
BACKGROUND: As the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. In this study, we explored the spectrum of causes of fever in African children. METHODS: We recruited children younger than 10 years of age with a temperature of 38°C or higher at two outpatient clinics - one rural and one urban - in Tanzania. Medical histories were obtained and clinical examinations conducted by means of systematic procedures. Blood and nasopharyngeal specimens were collected to perform rapid diagnostic tests, serologic tests, culture, and molecular tests for potential pathogens causing acute fever. Final diagnoses were determined with the use of algorithms and a set of prespecified criteria. RESULTS: Analyses of data derived from clinical presentation and from 25,743 laboratory investigations yielded 1232 diagnoses. Of 1005 children (22.6% of whom had multiple diagnoses), 62.2% had an acute respiratory infection; 5.0% of these infections were radiologically confirmed pneumonia. A systemic bacterial, viral, or parasitic infection other than malaria or typhoid fever was found in 13.3% of children, nasopharyngeal viral infection (without respiratory symptoms or signs) in 11.9%, malaria in 10.5%, gastroenteritis in 10.3%, urinary tract infection in 5.9%, typhoid fever in 3.7%, skin or mucosal infection in 1.5%, and meningitis in 0.2%. The cause of fever was undetermined in 3.2% of the children. A total of 70.5% of the children had viral disease, 22.0% had bacterial disease, and 10.9% had parasitic disease. CONCLUSIONS: These results provide a description of the numerous causes of fever in African children in two representative settings. Evidence of a viral process was found more commonly than evidence of a bacterial or parasitic process. Copyright © 2014 Massachusetts Medical Society.
Authors & Co-Authors
D'Acremont, Valérie
Switzerland, Basel
Universitat Basel
Switzerland, Lausanne
Université de Lausanne Unil
Tanzania
Dar es Salaam City Council
Kilowoko, Mary
Tanzania, Dar es Salaam
Amana Hospital
Kyungu, Esther
Tanzania
St. Francis Hospital
Philipina, Sister
Tanzania
St. Francis Hospital
Sangu, Willy
Tanzania, Dar es Salaam
Amana Hospital
Kahama-Maro, Judith
Switzerland, Basel
Universitat Basel
Tanzania
Dar es Salaam City Council
Lengeler, Christian H.
Switzerland, Basel
Universitat Basel
Cherpillod, Pascal
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Kaiser, Laurent K.
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Genton, Blaise
Switzerland, Basel
Universitat Basel
Switzerland, Lausanne
Université de Lausanne Unil
Switzerland, Lausanne
Centre Hospitalier Universitaire Vaudois
Tanzania, Ifakara
Ifakara Health Institute
Statistics
Citations: 375
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1056/NEJMoa1214482
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Tanzania