Quantifying the incidence of severe-febrile-illness hospital admissions in sub-Saharan Africa

Introduction: Diarrhoea is one of the main causes of morbidity and mortality among children in sub-Saharan Africa, and one of the main causes of hospital admissions in rural areas of Kenya. In Kenya, antimicrobial resistance surveillance has been conducted only at the institutional levels, with limited sharing of information and analysis of data. As a result, the actual scale of regional or national antimicrobial drug resistance is not well defined. Methodology: Stool samples were collected between 1 October 2007 and 30 September 2008 from a total of 651 outpatients with diarrhoea who were under five years of age in four provinces of Kenya. Conventional, biochemical methods, multiplex PCR and antimicrobial susceptibility were conducted to identify the bacterial causes and virulence factors in the isolates, respectively. Results: Of the 651 patients screened, we identified the causes of 115 cases (17.7%) as follows: Pathogenic E. coli (11.2%) [enteroaggregative (8.9%), enterotoxigenic (1.2%), enteroinvasive (0.6%), shigatoxigenic (0.5%)], Salmonella (3.5%), Shigella (2%) and Vibrio cholera O1 (0.7%). The highest levels of resistance among the E. coli isolates were observed in ampicillin and trimethoprim/sulphamethoxazole each at 95% followed by tetracycline at 81%. Shigella isolate levels of resistance ranged from 80% to 100% for ampicillin, tetracycline and trimethoprim/sulphamethoxazole. Conclusion: The highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin.

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Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030419 ◽

2019 ◽

Vol 16 (3) ◽

pp. 419 ◽

Cited By ~ 3

Author(s):

Herbert Chikafu ◽

Moses Chimbari

Keyword(s):

Cardiovascular Disease ◽

Healthcare Utilization ◽

Hospital Admissions ◽

Stroke Care ◽

Sub Saharan Africa ◽

Quantitative Methodology ◽

Healthcare Provision ◽

Cvd Risk ◽

Epidemiological Transitions ◽

Sub Saharan

Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008–2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.

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Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia

BMJ Open ◽

10.1136/bmjopen-2019-035632 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035632 ◽

Cited By ~ 1

Author(s):

Heidi Hopkins ◽

Quique Bassat ◽

Clare IR Chandler ◽

John A Crump ◽

Nicholas A Feasey ◽

...

Keyword(s):

Social Science ◽

Blood Sample ◽

Venous Blood ◽

Febrile Illness ◽

Clinical Diagnostics ◽

Control Measures ◽

Sub Saharan Africa ◽

Venous Blood Sample ◽

Open Access Journals ◽

Sub Saharan

IntroductionFever commonly leads to healthcare seeking and hospital admission in sub-Saharan Africa and Asia. There is only limited guidance for clinicians managing non-malarial fevers, which often results in inappropriate treatment for patients. Furthermore, there is little evidence for estimates of disease burden, or to guide empirical therapy, control measures, resource allocation, prioritisation of clinical diagnostics or antimicrobial stewardship. The Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study seeks to address these information gaps.Methods and analysisFIEBRE investigates febrile illness in paediatric and adult outpatients and inpatients using standardised clinical, laboratory and social science protocols over a minimum 12-month period at five sites in sub-Saharan Africa and Southeastern and Southern Asia. Patients presenting with fever are enrolled and provide clinical data, pharyngeal swabs and a venous blood sample; selected participants also provide a urine sample. Laboratory assessments target infections that are treatable and/or preventable. Selected point-of-care tests, as well as blood and urine cultures and antimicrobial susceptibility testing, are performed on site. On day 28, patients provide a second venous blood sample for serology and information on clinical outcome. Further diagnostic assays are performed at international reference laboratories. Blood and pharyngeal samples from matched community controls enable calculation of AFs, and surveys of treatment seeking allow estimation of the incidence of common infections. Additional assays detect markers that may differentiate bacterial from non-bacterial causes of illness and/or prognosticate illness severity. Social science research on antimicrobial use will inform future recommendations for fever case management. Residual samples from participants are stored for future use.Ethics and disseminationEthics approval was obtained from all relevant institutional and national committees; written informed consent is obtained from all participants or parents/guardians. Final results will be shared with participating communities, and in open-access journals and other scientific fora. Study documents are available online (https://doi.org/10.17037/PUBS.04652739).

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CLINICAL AND HEMATOLOGICAL EFFECTS OF HYDROXYUREA THERAPY IN MANAGEMENT OF SICKLE CELL ANEMIA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i7.383 ◽

2019 ◽

Vol 3 (7) ◽

Author(s):

Dr. Rajesh Shukla ◽

Dr. Mehul Gajera

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Hospital Admissions ◽

White Blood Cells ◽

Sub Saharan Africa ◽

P Value ◽

Cell Disease ◽

Hematological Effects ◽

Sub Saharan ◽

Hydroxyurea Therapy

Background: The most predominant form of haemoglobinopathy worldwide is sickle cell disease. The greatest burden of the disease lies in sub-Saharan Africa and Asia5. Objective: To evaluate the effectiveness of HU therapy in sickle cell disease as measured by decrease in crises rate, hospital admissions, days of hospitalization and number of blood transfusions. Methods: the study was conducted on 79 children of 1-16 year age. Out of which in only 75 patients Hydroxyurea therapy was started as they were found to be eligible. 16% of the patients responded to 15 mg/kg/ day of HU, 50.66% responded to 20 mg/kg/ day, 29.33% to 25 mg/kg/ day and only 4% needed a dose escalation to 30 mg/kg/ day for the response. Results: Our study showed a significant reduction in the VOC rate from 243 episodes to 46 episodes (p value <0.001), the number of ACS reduced from 37 episodes to 5 episodes (p value <0.001), also there is a significant decline in the rates of hemolytic crises from 63 episodes to 10 episodes per year, Significant increase in the HbF levels from 15.87±5.50% to 21.77.±4.06% (p value <0.001). There was a definite and significant reduction in the number of hospitalization days from 7.76±4.76 to 3.79±2.29 days and in the number of admissions per year dropped significantly from 4.80 ± 1.41 to 1.42± 0.61 per year. Conclusion: Hydroxyurea reduced the frequency of painful crises and diminished the number of hospitalization, transfusion, and episodes of acute chest syndrome17. Keywords: Haemoglobin (Hb), Hydroxyurea (HU), Mean Corpuscular Volume (MCV), Pletelet Counts, Sickle Cell Disease (SCD), White Blood Cells (WBC).

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The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2018.02.011 ◽

2018 ◽

Vol 24 (8) ◽

pp. 808-814 ◽

Cited By ~ 28

Author(s):

M.J. Maze ◽

Q. Bassat ◽

N.A. Feasey ◽

I. Mandomando ◽

P. Musicha ◽

...

Keyword(s):

Febrile Illness ◽

Sub Saharan Africa ◽

Diagnosis And Management ◽

Sub Saharan

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Rickettsioses and Q Fever in Tanzania: Estimating the Burden of Pervasive and Neglected Causes of Severe Febrile Illness in Sub-Saharan Africa

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0963 ◽

2021 ◽

Author(s):

Paul W. Blair ◽

Mohammed Lamorde ◽

J. Stephen Dumler

Keyword(s):

Q Fever ◽

Febrile Illness ◽

Sub Saharan Africa ◽

Sub Saharan

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Malaria and Chikungunya Detected Using Molecular Diagnostics Among Febrile Kenyan Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx110 ◽

2017 ◽

Vol 4 (3) ◽

Cited By ~ 14

Author(s):

Jesse Waggoner ◽

Julie Brichard ◽

Francis Mutuku ◽

Bryson Ndenga ◽

Claire Jane Heath ◽

...

Keyword(s):

Real Time ◽

Clinical Diagnosis ◽

Lake Victoria ◽

Febrile Illness ◽

Primary Diagnosis ◽

Sub Saharan Africa ◽

Lake Victoria Region ◽

The Indian Ocean ◽

Polymerase Chain ◽

Sub Saharan

Abstract Background In sub-Saharan Africa, malaria is frequently overdiagnosed as the cause of an undifferentiated febrile illness, whereas arboviral illnesses are presumed to be underdiagnosed. Methods Sera from 385 febrile Kenyan children, who presented to 1 of 4 clinical sites, were tested using microscopy and real-time molecular assays for dengue virus (DENV), chikungunya virus (CHIKV), malaria, and Leptospira. Results Malaria was the primary clinical diagnosis for 254 patients, and an arboviral infection (DENV or CHIKV) was the primary diagnosis for 93 patients. In total, 158 patients (41.0%) had malaria and 32 patients (8.3%) had CHIKV infections. Compared with real-time polymerase chain reaction, microscopy demonstrated a percent positive agreement of 49.7%. The percentage of malaria cases detected by microscopy varied significantly between clinical sites. Arboviral infections were the clinical diagnosis for patients on the Indian Ocean coast (91 of 238, 38.2%) significantly more often than patients in the Lake Victoria region (2 of 145, 1.4%; P < .001). However, detection of CHIKV infections was significantly higher in the Lake Victoria region (19 of 145 [13.1%] vs 13 of 239 [5.4%]; P = .012). Conclusions The clinical diagnosis of patients with an acute febrile illness, even when aided by microscopy, remains inaccurate in malaria-endemic areas, contributing to inappropriate management decisions.

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Dengue in western Uganda: A prospective cohort of children presenting with undifferentiated febrile illness

10.1101/2020.08.21.20179002 ◽

2020 ◽

Author(s):

Ross M. Boyce ◽

Matthew Collins ◽

Rabbison Muhindo ◽

Regina Nakakande ◽

Emily J Ciccone ◽

...

Keyword(s):

Rapid Test ◽

Febrile Illness ◽

Sub Saharan Africa ◽

Urban Site ◽

Igg Antibodies ◽

Rt Pcr ◽

Elisa Testing ◽

Sub Saharan ◽

Western Uganda ◽

Ecological Suitability

Background: The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of urbanicity and malaria transmission intensity. Methods: Eligible children were first screened for malaria using rapid diagnostic tests. Children with a negative malaria result were tested for dengue using a combination NS1/IgM/IgG rapid test (SD Bioline Dengue Duo). Confirmatory testing by RT-PCR was performed in a subset of participants. Antigen-capture ELISA was performed to estimate seroprevalence. Results: Only 6 of 1,416 (0.42%) children had a positive dengue rapid test, while none of the RT-PCR results were positive. ELISA testing demonstrated reactive IgG antibodies in 28 (2.2%) participants with the highest prevalence seen at the urban site in Mbarara (19 of 392, 4.9%, p<0.001). Conclusions: Overall, these findings suggest that dengue, while present, is an uncommon cause of non-malarial, pediatric febrile illness in western Uganda. Further investigation into the eocological factors that sustain low-level transmission in urban settings are urgently needed to reduce the risk of epidemics.

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The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

10.1101/2021.04.12.21255327 ◽

2021 ◽

Author(s):

Stephen Sevalie ◽

Daniel Youkee ◽

Alex J van Duinen ◽

Emma Bailey ◽

Thaimu Bangura ◽

...

Keyword(s):

Health Service ◽

Sierra Leone ◽

Health Systems ◽

Hospital Admissions ◽

Health Service Utilisation ◽

Sub Saharan Africa ◽

Service Utilisation ◽

Hospital Data ◽

Sub Saharan ◽

The Impact

Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

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