CONFIT - Causes Of Non-malaria Febrile Illness in Tanzania
2011 - 2013
For many years, presumptive diagnosis of malaria has been policy in malaria-endemic countries but the increasing cost of antimalarial drugs and availability of diagnostic devices is driving a change. The most recent guidelines in Tanzania (2006) recommend restricting antimalarial drugs in patients over the age of five years to those with parasitological evidence of malaria and the most recent WHO Guidelines (2010) now recommend parasitological testing to guide antimalarial drug use in all ages. To support this change there is an urgent need to know more about non-malarial febrile illness in Tanzania and generally in resource-poor countries of Africa and Asia.
In contrast to antimalarials, antibiotic treatment is still presumptively given and the aetiology of disease remains unknown in most cases. Few studies have explored antimicrobial resistance in sub--Saharan Africa but some reports present alarming degrees of therapeutic limitations of first line antibiotics against common disease-causing bacteria. High resistance levels may force countries to turn into use of more expensive first line antibiotics. This increases the need of improved diagnostics, through clinical or biomedical markers, in order to limit costs in already burdened health budgets.
To present alternative microbiological causes of acute febrile illness in children and adults with a negative rapid diagnostic test for malaria and to identify predictors/point of the care tests (POC) for bacterial illness that can be easily used in resource-poor settings.
Patients from 3 months to 50 years of age who present with acute febrile illness will be recruited in a prospective cohort-study at the outpatient department of Teule hospital, Tanzania. Diagnosis will be done through chest X-rays and laboratory tests including blood, sputum, urine and faeces culture. POC tests will be done for evaluation of performance. Patients will be followed on day 2, 7 and 14 after enrolment to capture improvement failures and estimate possible predictors of treatment failure. The prevalence of naso-pharyngeal pathogens in patients with symptoms of pneumonia will be compared with the naso-pharyngeal carriage in asymptomatic community members (control group). The expected outcomes are: 1) aetiologies of non-malaria acute febrile illness 2) aetiologies of pneumonia symptoms 3) antimicrobial resistance patterns 4) predictors of viral versus bacterial disease 5) predictors of mild versus severe disease. The study results will inform policies on management of non-malarial febrile illness including identification of bacterial illness, choice of antibiotic treatment and predictors capable of identifying patients at risk of developing severe illness.