Abstract
ObjectivesAreas with declining malaria transmission in sub-Saharan Africa have recently witnessed important changes in the aetiology of childhood acute febrile illness (AFI). We describe the aetiology of AFI in a high malaria transmission area in rural Burkina Faso. MethodsIn a prospective hospital-based diagnostic study, children aged 3 months to 15 years with AFI were recruited and assessed using a systematic diagnostic protocol, including blood cultures, whole blood PCR on a selection of bacterial pathogens, malaria diagnostics and a multiplex PCR on nasopharyngeal swabs targeting 21 viral and 4 bacterial respiratory pathogens. ResultsA total of 589 children with AFI were enrolled from whom an infectious disease was considered in 575 cases. Acute respiratory tract infections, malaria and invasive bacterial infections (IBI) accounted for 179 (31.1%), 175 (30.4%) and 75 (13%) of AFI cases respectively; 16 (21.3%) of IBI cases also had malarial parasitaemia. A viral pathogen was demonstrated from the nasopharynx in 157 children (90.7%) with respiratory tract symptoms. Of all children with viral respiratory tract infections, 154 (92.4% received antibiotics, whereas no antibiotic was provided in 13 (17%) of IBI cases. ConclusionsViral respiratory infections are a common cause of childhood AFI in high malaria transmission areas, next to malaria and IBI. These findings highlight the importance of interventions to improve targeted treatment with antimicrobials. Most patients with viral infections received antibiotics unnecessarily, while a considerable number with IBI did not receive antibiotics.
Highlights
Acute febrile illnesses (AFI) in children remain a major public health problem in sub-Saharan Africa (SSA)
Given the importance of surveillance of causes of AFI for clinical management and design of diagnostic tools and public health strategies in high malaria transmission areas in West Africa, we investigated the aetiologies of AFI in children presenting to a referral hospital in rural Burkina Faso
acute respiratory infections (ARI) was predominant in children younger than 2 years old, followed by malaria, whereas malaria was more common in those aged 2 to less than 10 years
Summary
Acute febrile illnesses (AFI) in children remain a major public health problem in sub-Saharan Africa (SSA). The past decade has seen major changes in infectious diseases patterns in many areas in SSA because of efforts in malaria control strategies as well as the introduction of new vaccines [1e3]. B. Kabore et al / Clinical Microbiology and Infection 27 (2021) 590e596. Enough to determine the aetiology of infection. With the exception of malaria diagnostic tests, diagnostic tools are frequently not or only very limitedly available. AFI is commonly treated empirically with antimalarials and/or antibiotics [4e6]. This practice has important disadvantages in view of the rapidly increasing burden of antimicrobial resistance. It is important to gain insight into the epidemiology of nonmalarial febrile illness in SSA
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