Abstract:
Background: The diagnostic challenges of febrile illness in children in low-
resource settings and the risks of empirical overtreatment. We evaluated the
range of clinical presentations and management outcomes in a cohort of
children with acute febrile illness, building on our previous examination of the
etiology of these illnesses.
Methods: This prospective cohort study enrolled children aged 1 to ≤12 years
who were cared for by attending clinicians across primary, secondary, and
tertiary healthcare settings. Management decisions were based on clinical
presentation and laboratory and radiographic findings available on the day of
enrollment. Outcomes were measured on days 7, 14, and 28. The study also
analyzed prescription patterns for antibiotics and antimalarials in relation to
established guidelines.
Results: In this cohort of 434 children with acute febrile illness, the most
common initial diagnoses were acute respiratory infections (31.3%, 136/434),
of which upper respiratory tract infection (URTI) was observed in 57.0% (77/
136) and pneumonia in 43.0% (59/136), followed by malaria (23.7%, 103/434).
Antibacterial agents were prescribed to 65.3% (284/434) of children. Antibiotic
overprescription was observed in 29.6% (84/285) of study participants.
Antimalarial drugs were prescribed to 38.9% (169/434) of patients, including
103 patients judged to have malaria by a positive MRDT or a positive blood
smear. A total of 66 (39.0%) patients who received antimalarial drugs were
negative for either MRDT or blood smear. Fever resolved in 398 children
(96.0%, 386/402) by day 28 of follow-up. The most commonly documented
complications among admitted children included anemia (36.0%), dehydration
(9.1%), shock (8.5%), and acute kidney injury (8.5%). Overall mortality at day 28
was 1.0% (4/434). Conclusion: In environments with limited diagnostic resources, children with
acute febrile illness are often treated empirically. This results in significant
over prescription of antibiotics and antimalarials. While short-term results are
usually positive, such practices raise concerns about antimicrobial resistance
and adherence to guidelines. Better access to point-of-care diagnostics can
help decrease inappropriate prescriptions and improve care quality.