Volume 92, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



There is a paucity of data on the etiologies and outcomes of febrile illness in rural Sierra Leone, especially in the Lassa-endemic district of Kenema. We conducted a retrospective study of patients with subjective or documented fever (T ≥ 38.0°C) who were admitted to a rural tertiary care hospital in Kenema between November 1, 2011 and October 31, 2012. Of 854 patients admitted during the study period, 429 (50.2%) patients had fever on admission. The most common diagnoses were malaria (27.3%), pneumonia (5.1%), and Lassa fever (4.9%). However, 53.4% of febrile patients had no diagnosis at discharge. The in-hospital mortality rate was 18.9% and associated with documented temperature ≥ 38.0°C (adjusted odds ratio [AOR] = 2.89, = 0.001) and lack of diagnosis at discharge (AOR = 2.04, = 0.03). Failure to diagnose the majority of febrile adults and its association with increased mortality highlight the need for improved diagnostic capacity to improve patient outcomes.


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  1. Crump JA, Gove S, Parry CM, , 2011. Management of adolescents and adults with febrile illness in resource limited areas. BMJ 343: d4847.[Crossref] [Google Scholar]
  2. Ansumana R, Jacobsen KH, Gbakima AA, Hodges MH, Lamin JM, Leski TA, Malanoski AP, Lin B, Bockarie MJ, Stenger DA, , 2013. Presumptive self-diagnosis of malaria and other febrile illnesses in Sierra Leone. Pan Afr Med J 15: 34.[Crossref] [Google Scholar]
  3. Branco LM, Grove JN, Boisen ML, Shaffer JG, Goba A, Fullah M, Momoh M, Grant DS, Garry RF, , 2011. Emerging trends in Lassa fever: redefining the role of immunoglobulin M and inflammation in diagnosing acute infection. Virol J 8: 478.[Crossref] [Google Scholar]
  4. Gakuruh T, , 2009. Sierra Leone. Available at: http://www.who.int/countries/sle/en/. Accessed November 14, 2013. [Google Scholar]
  5. Nnedu ON, Rimel B, Terry C, Jalloh-Vos H, Baryon B, Bausch DG, , 2010. Syndromic diagnosis of malaria in rural Sierra Leone and proposed additions to the national integrated management of childhood illness guidelines for fever. Am J Trop Med Hyg 82: 525528.[Crossref] [Google Scholar]
  6. UNAIDS, 2012. Sierra Leone. Available at: http://www.unaids.org/en/regionscountries/countries/sierraleone/. Accessed November 14, 2013. [Google Scholar]
  7. Leone SS, , 2004. Population Census. Available at: http://www.statistics.sl/publications.htm. Accessed December 7, 2013. [Google Scholar]
  8. Chandler CI, Jones C, Boniface G, Juma K, Reyburn H, Whitty CJ, , 2008. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study. Malar J 7: 53.[Crossref] [Google Scholar]
  9. Leslie T, Mikhail A, Mayan I, Anwar M, Bakhtash S, Nader M, Chandler C, Whitty CJ, Rowland M, , 2012. Overdiagnosis and mistreatment of malaria among febrile patients at primary healthcare level in Afghanistan: observational study. BMJ 345: e4389.[Crossref] [Google Scholar]
  10. Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJ, , 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329: 1212.[Crossref] [Google Scholar]
  11. Roucher C, Rogier C, Dieye-Ba F, Sokhna C, Tall A, Trape JF, , 2012. Changing malaria epidemiology and diagnostic criteria for Plasmodium falciparum clinical malaria. PLoS ONE 7: e46188.[Crossref] [Google Scholar]
  12. Nadjm B, Mtove G, Amos B, Walker NF, Diefendal H, Reyburn H, Whitty CJ, , 2012. Severe febrile illness in adult hospital admissions in Tanzania: a prospective study in an area of high malaria transmission. Trans R Soc Trop Med Hyg 106: 688695.[Crossref] [Google Scholar]
  13. Reddy EA, Shaw AV, Crump JA, , 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417432.[Crossref] [Google Scholar]
  14. Sokhna C, Mediannikov O, Fenollar F, Bassene H, Diatta G, Tall A, Trape JF, Drancourt M, Raoult D, , 2013. Point-of-care laboratory of pathogen diagnosis in rural Senegal. PLoS Negl Trop Dis 7: e1999.[Crossref] [Google Scholar]
  15. Ansumana R, Jacobsen KH, Gbakima AA, Hodges MH, Lamin JM, Leski TA, Malanoski AP, Lin B, Bockarie MJ, Stenger DA, , 2013. Presumptive self-diagnosis of malaria and other febrile illnesses in Sierra Leone. Pan Afr Med J 15: 34.[Crossref] [Google Scholar]
  16. Thomson A, Khogali M, de Smet M, Reid T, Mukhtar A, Peterson S, von Schreeb J, , 2011. Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone. Malar J 10: 94.[Crossref] [Google Scholar]
  17. World Health Organization, 2014. World Health Statistics 2014. Geneva: World Health Organization, 7289. [Google Scholar]

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  • Received : 04 Jul 2014
  • Accepted : 16 Sep 2014
  • Published online : 07 Jan 2015

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