Abstract
BackgroundGlobal prioritization of single-disease eradication programs over improvements to basic diagnostic capacity in the Global South have left the world unprepared for epidemics of chikungunya, Ebola, Zika, and whatever lies on the horizon. The medical establishment is slowly realizing that in many parts of sub-Saharan Africa (SSA), particularly urban areas, up to a third of patients suffering from acute fever do not receive a correct diagnosis of their infection.Main bodyMalaria is the most common diagnosis for febrile patients in low-resource health care settings, and malaria misdiagnosis has soared due to the institutionalization of malaria as the primary febrile illness of SSA by international development organizations and national malaria control programs. This has inadvertently created a “malaria-industrial complex” and historically obstructed our complete understanding of the continent’s complex communicable disease epidemiology, which is currently dominated by a mélange of undiagnosed febrile illnesses. We synthesize interdisciplinary literature from Ghana to highlight the complexity of communicable disease care in SSA from biomedical, social, and environmental perspectives, and suggest a way forward.ConclusionA socio-environmental approach to acute febrile illness etiology, diagnostics, and management would lead to substantial health gains in Africa, including more efficient malaria control. Such an approach would also improve global preparedness for future epidemics of emerging pathogens such as chikungunya, Ebola, and Zika, all of which originated in SSA with limited baseline understanding of their epidemiology despite clinical recognition of these viruses for many decades. Impending ACT resistance, new vaccine delays, and climate change all beckon our attention to proper diagnosis of fevers in order to maximize limited health care resources.
Highlights
Global prioritization of single-disease eradication programs over improvements to basic diagnostic capacity in the Global South have left the world unprepared for epidemics of chikungunya, Ebola, Zika, and whatever lies on the horizon
A socio-environmental approach to acute febrile illness etiology, diagnostics, and management would lead to substantial health gains in Africa, including more efficient malaria control
A socio-environmental approach to acute febrile illness etiology, diagnostics, and management provides several opportunities for integrated research into: (1) scalability of recent advances in diagnostic technology both in the lab and field; (2) geo-demographic and socio-environmental correlates of specific communicable diseases that contribute to SSA’s febrile illness burden; (3) the environmental and human behavioral drivers of vector breeding, as well as assessing integrated vector management techniques that have been successfully deployed in other tropical urban contexts; and (4) the testing of various communitylevel educational and behavioral interventions related to febrile illness knowledge and care-seeking, given the matrix of caregivers available within relatively close proximity in any large sub-Saharan African city
Summary
A socio-environmental approach to acute febrile illness etiology, diagnostics, and management provides several opportunities for integrated research into: (1) scalability of recent advances in diagnostic technology both in the lab and field; (2) geo-demographic and socio-environmental correlates of specific communicable diseases that contribute to SSA’s febrile illness burden; (3) the environmental and human behavioral drivers of vector breeding, as well as assessing integrated vector management techniques that have been successfully deployed in other tropical urban contexts; and (4) the testing of various communitylevel educational and behavioral interventions related to febrile illness knowledge and care-seeking, given the matrix of caregivers (family, pharmacists, physicians, traditional healers, etc.) available within relatively close proximity in any large sub-Saharan African city Toward these ends, we summarize some proposed key solutions ranging from clinical to institutional scales: Renew the focus on differential diagnosis in tropical medicine and public health training; Initiate or improve community-level health communication about febrile illness causes and care; Pilot the reallocation of malaria-related health care resources in low-transmission urban settings to support febrile illness diagnostics (which includes malaria); Encourage local and international funding agencies to prioritize health worker training and laboratory diagnostic capacity.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
