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Evaluation of in-hospital management for febrile illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the treatment of malaria.

dc.contributor.author Biggs, HM
dc.contributor.author Crump, John Andrew
dc.contributor.author Maro, Venance P
dc.contributor.author Moon, AM
dc.contributor.author Reddy, Elizabeth A
dc.contributor.author Rubach, MP
dc.contributor.author Saganda, W
dc.coverage.spatial United States
dc.date.accessioned 2017-03-02T19:10:39Z
dc.date.available 2017-03-02T19:10:39Z
dc.date.issued 2014
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/24587056
dc.identifier PONE-D-13-35569
dc.identifier.uri http://hdl.handle.net/10161/13775
dc.description.abstract OBJECTIVE: In 2010, the World Health Organization (WHO) published updated guidelines emphasizing and expanding recommendations for a parasitological confirmation of malaria before treating with antimalarials. This study aimed to assess differences in historic (2007-2008) (cohort 1) and recent (2011-2012) (cohort 2) hospital cohorts in the diagnosis and treatment of febrile illness in a low malaria prevalence area of northern Tanzania. MATERIALS AND METHODS: We analyzed data from two prospective cohort studies that enrolled febrile adolescents and adults aged ≥13 years. All patients received quality-controlled aerobic blood cultures and malaria smears. We compared patients' discharge diagnoses, treatments, and outcomes to assess changes in the treatment of malaria and bacterial infections. RESULTS: In total, 595 febrile inpatients were enrolled from two referral hospitals in Moshi, Tanzania. Laboratory-confirmed malaria was detected in 13 (3.2%) of 402 patients in cohort 1 and 1 (0.5%) of 193 patients in cohort 2 (p = 0.041). Antimalarials were prescribed to 201 (51.7%) of 389 smear-negative patients in cohort 1 and 97 (50.5%) of 192 smear-negative patients in cohort 2 (p = 0.794). Bacteremia was diagnosed from standard blood culture in 58 (14.5%) of 401 patients in cohort 1 compared to 18 (9.5%) of 190 patients in cohort 2 (p = 0.091). In cohort 1, 40 (69.0%) of 58 patients with a positive blood culture received antibacterials compared to 16 (88.9%) of 18 patients in cohort 2 (p = 0.094). In cohort 1, 43 (10.8%) of the 399 patients with known outcomes died during hospitalization compared with 12 (6.2%) deaths among 193 patients in cohort 2 (p = 0.073). DISCUSSION: In a setting of low malaria transmission, a high proportion of smear-negative patients were diagnosed with malaria and treated with antimalarials despite updated WHO guidelines on malaria treatment. Improved laboratory diagnostics for non-malaria febrile illness might help to curb this practice.
dc.language eng
dc.relation.ispartof PLoS One
dc.relation.isversionof 10.1371/journal.pone.0089814
dc.subject Adolescent
dc.subject Adult
dc.subject Antimalarials
dc.subject Cohort Studies
dc.subject Diagnosis, Differential
dc.subject Fever
dc.subject Guideline Adherence
dc.subject Humans
dc.subject Malaria
dc.subject Prospective Studies
dc.subject Tanzania
dc.subject Treatment Outcome
dc.subject World Health Organization
dc.title Evaluation of in-hospital management for febrile illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the treatment of malaria.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/24587056
pubs.begin-page e89814
pubs.issue 2
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Pathology
pubs.organisational-group School of Medicine
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published online
pubs.volume 9
dc.identifier.eissn 1932-6203


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