Abstract
Background: Limited confirmatory tests are routinely performed in Ghanaian District hospitals for febrile illnesses beyond the malaria Rapid Diagnostic Test (RDT) and the Complete Blood Count (CBC). Recent surveys demonstrate a declining role of malaria as the prominent cause of childhood fever. This study evaluates febrile presentations among children under five years (U-5) on arrival at the pediatric unit of the Dormaa Presbyterian Hospital (DPH), making comparison with the GDHS 2014 report. The potential role of the Complete Blood Count (CBC) in evaluating childhood febrile presentation is also examined. Methods and Findings: Multiple data entry forms were used to retrospectively obtain patients’ clinical parameters. Patients enrolled for the study comprised children from 6 months to 5 years (children U-5), presenting with fever (temperature ≥ 37.5°C) to the DPH pediatric unit between March and June 2014. Data was analyzed using descriptive statistics. 61.9% (57.76%-66.04% at 95% CI) of all the febrile children tested Rapid Diagnostic Test (RDT)-positive for malaria at presentation. 58.6% (51.52%-65.68%, at 95% CI) of non-malaria febrile children had normal White Blood Cell (WBC) counts. Conclusion: The high prevalence of malaria-related febrile illnesses among children U-5 in DPH does not reflect the declining national estimate reported for the same period. Such a high local U-5 malaria prevalence may warrant not only the allocation of appropriate resources but an epidemiological re-evaluation of peculiar malaria patterns in this district. The WBC count alone is unlikely to be reliable for the diagnostic evaluation of non-malarial febrile illness in children U-5.
Highlights
Febrile illnesses are common clinical presentations in most tropical countries and microbial infections form the most important etiology [1,2]
A febrile U-5 child who tested malaria-Rapid Diagnostic Test (RDT) positive was identified as having a malaria-related or malaria-associated fever. Those testing negative for the malaria RDT have been described as having a non-malarial febrile illness or presentation
Malaria remains hyper-endemic in the DPH catchment area and it is still the dominant cause of febrile illnesses among childrenunder-5-years (U-5) reporting to the Dormaa Presbyterian Hospital
Summary
Febrile illnesses are common clinical presentations in most tropical countries and microbial infections form the most important etiology [1,2]. The malaria-RDT is carried out as part of the fever management routine even when the history and examination findings may not be suggestive of the diagnosis. It is essential, that the proportion of febrile illnesses that are not malaria-related is appropriately investigated, especially, with the dip in dominance of malaria as the leading cause of febrile illnesses in some tropical studies [6]. The GDHS 2014 findings suggest that a reasonable population of febrile children under-5 may not have malaria and could require, perhaps, further investigations to ascertain their diagnosis. The potential role of the Complete Blood Count (CBC) in evaluating childhood febrile presentation is examined
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