Changing etiologies in childhood acute febrile illness: implications for management in an era of declining malaria
type: CreativeWork
description: Background: Acute febrile illness (AFI) is a common syndrome among children presenting to a healthcare facility in resource-limited settings and a substantial contributor to childhood mortality. In sub-Saharan Africa, malaria has historically been a leading cause of childhood AFI but malaria incidence and mortality have declined dramatically over the past decade. At the same time, other emerging infections may increasingly be replacing malaria as causes of AFI. For example, dengue virus has spread rapidly throughout the world and is now established in Africa. It is unclear how shifts in pathogen distribution and transmission impact AFI incidence and how these changes impact the management practices of healthcare workers (HCWs). This dissertation sought to describe recent time trends of malaria and non-malarial AFI (Aim 1), to evaluate the contribution of dengue to AFI in western Kenya (Aim 2), and determine whether seasonal variations in malaria incidence influence antibiotic prescribing for children with AFI (Aim 3). Methods: All three aims were addressed using data from a large cohort in western Kenya that has been followed for over eight years. In particular, data from Lwak Mission Hospital formed the basis for these analyses. For Aim 1, quasi-Poisson regression was used to calculate the annual decline in visits from children with malaria, non-malarial AFI, and overall AFI. For Aim 2, serum specimens were obtained from patients of all ages with AFI who had either no known cause of their fever or a diagnosis for which dengue fever is often mistaken. Specimens were tested for the presence of dengue virus using reverse-transcription polymerase chain reaction (PCR). In addition, specimens were also tested for evidence of a recent infection, indicated by the presence of IgM anti-dengue virus antibodies in an enzyme-linked immunosorbent assay. For Aim 3, we used logistic regression, adjusting for a child’s malaria smear result, to assess whether seasonal variations in …
abstract: Background: Acute febrile illness (AFI) is a common syndrome among children presenting to a healthcare facility in resource-limited settings and a substantial contributor to childhood mortality. In sub-Saharan Africa, malaria has historically been a leading cause of childhood AFI but malaria incidence and mortality have declined dramatically over the past decade. At the same time, other emerging infections may increasingly be replacing malaria as causes of AFI. For example, dengue virus has spread rapidly throughout the world and is now established in Africa. It is unclear how shifts in pathogen distribution and transmission impact AFI incidence and how these changes impact the management practices of healthcare workers (HCWs). This dissertation sought to describe recent time trends of malaria and non-malarial AFI (Aim 1), to evaluate the contribution of dengue to AFI in western Kenya (Aim 2), and determine whether seasonal variations in malaria incidence influence antibiotic prescribing for children with AFI (Aim 3). Methods: All three aims were addressed using data from a large cohort in western Kenya that has been followed for over eight years. In particular, data from Lwak Mission Hospital formed the basis for these analyses. For Aim 1, quasi-Poisson regression was used to calculate the annual decline in visits from children with malaria, non-malarial AFI, and overall AFI. For Aim 2, serum specimens were obtained from patients of all ages with AFI who had either no known cause of their fever or a diagnosis for which dengue fever is often mistaken. Specimens were tested for the presence of dengue virus using reverse-transcription polymerase chain reaction (PCR). In addition, specimens were also tested for evidence of a recent infection, indicated by the presence of IgM anti-dengue virus antibodies in an enzyme-linked immunosorbent assay. For Aim 3, we used logistic regression, adjusting for a child’s malaria smear result, to assess whether seasonal variations in …
author: Matheson, Alastair
language: en_US
keywords: Acute febrile illness; Antibiotics; Child; Global Health; Malaria
date published: 2016-04-06
date modified: 2026-07-24T05:58:27Z
provider: University of Washington
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Washington

PropertyValue
property ID: Handle
value: http://hdl.handle.net/1773/35579