1921
Volume 99, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Not much is known about clinical decision-making in rural, low-resource settings regarding fever, a common reason for presentation to care. In this prospective cohort study of patients presenting with febrile illness to a rural Ugandan health center, we examined demographic and clinical factors predictive of an initial disposition of inpatient admission after clinical evaluation, but before laboratory testing. We then assessed the association of laboratory results and system factors with a change between initial and final disposition plans. Four thousand nine hundred twenty-four patients with suspected febrile illness were included in the primary analysis. The strongest predictors for an initial disposition of admission after clinical examination were impaired consciousness (adjusted risk ratio [aRR], 3.21; 95% confidence interval [CI]: 2.44–4.21) and fever on examination (aRR, 2.27; 95% CI: 1.79–2.87). Providers initially planned to discharge patients with significant vital sign abnormalities, including tachypnea (3.6%) and hypotension (1.3%). Anemia strongly predicted a final disposition of admission after an initial disposition of discharge (aRR, 48.34; 95% CI: 24.22–96.49); other laboratory abnormalities, including hypoglycemia and acidosis, did not change disposition planning. In those with an initial disposition of admission, living farther than the two neighboring villages was associated with a final disposition of discharge (aRR, 2.12; 95% CI: 1.10–4.12). A concerning number of patients with abnormal vital signs and laboratory results were not admitted for inpatient care. Geographic factors may influence a patient’s final disposition contrary to a provider’s initial disposition plan. Future work should assess longer term outcomes after discharge and a broader study population.

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References

  1. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, Aura B, Burke H, Njenga MK, Williamson J, Breiman RF, , 2011. The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and Urban Kenya. PLoS One 6: 110. [Google Scholar]
  2. Crump JA, Kirk MD, , 2015. Estimating the burden of febrile illnesses. PLoS Negl Trop Dis 9: 17. [Google Scholar]
  3. Prasad N, Sharples KJ, Murdoch DR, Crump JA, , 2015. Community prevalence of fever and relationship with malaria among infants and children in low-resource areas. Am J Trop Med Hyg 93: 178180. [Google Scholar]
  4. Crump JA, 2013. Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis 7: e2324. [Google Scholar]
  5. Prasad N, Murdoch DR, Reyburn H, Crump JA, , 2015. Etiology of severe febrile illness in low- and middle-income countries: a systematic review. PLoS One 10: 125. [Google Scholar]
  6. D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B, , 2014. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med 370: 809817. [Google Scholar]
  7. Boyce RM, O’Meara WP, , 2017. Use of malaria RDTs in various health contexts across sub-Saharan Africa: a systematic review. BMC Public Health 17: 115. [Google Scholar]
  8. Boyce RM, Muiru A, Reyes R, Ntaro M, Mulogo E, Matte M, Siedner MJ, , 2015. Impact of rapid diagnostic tests for the diagnosis and treatment of malaria at a peripheral health facility in western Uganda: an interrupted time series analysis. Malar J 14: 203. [Google Scholar]
  9. Odaga J, Sinclair D, Lokong JA, Donegan S, Hopkins H, Garner P, , 2014. Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings. Cochrane Database Syst Rev 4: 151. [Google Scholar]
  10. Murungi M, 2017. Improving the specificity of Plasmodium falciparum malaria diagnosis in high-transmission settings with a two-step rapid diagnostic test and microscopy algorithm. J Clin Microbiol 55: 15401549. [Google Scholar]
  11. Grandesso F, Nabasumba C, Nyehangane D, Page AL, Bastard M, De Smet M, Boum Y, Etard JF, , 2016. Performance and time to become negative after treatment of three malaria rapid diagnostic tests in low and high malaria transmission settings. Malar J 15: 496. [Google Scholar]
  12. World Health Organization, 2014. Severe malaria. Trop Med Int Health 19 (Suppl 1): 7131. [Google Scholar]
  13. Boyce R, Reyes R, Keeler C, Matte M, Ntaro M, Mulogo E, Siedner MJ, , 2018. Anemia was an uncommon complication of severe malaria in a high-transmission rural area of western Uganda. Am J Trop Med Hyg 98: 683691. [Google Scholar]
  14. Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, Talisuna A, D’Alessandro U, , 2011. Case management of severe malaria—a forgotten practice: experiences from health facilities in Uganda. PLoS One 6: e17053. [Google Scholar]
  15. Ministry of Health Uganda, 2009. Malaria Indicator Survey (MIS) 2009, 144. Available at: http://www.measuredhs.com/pubs/pdf/MIS6/MIS6.pdf. Accessed June 7, 2018.
  16. Ministry of Health Uganda, 2015. Malaria Indicator Survey (MIS) 2014–2015, 144. Available at: http://www.measuredhs.com/pubs/pdf/MIS6/MIS6.pdf. Accessed June 7, 2018.
  17. Zou G, , 2004. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159: 702706. [Google Scholar]
  18. Sypniewska P, Duda JF, Locatelli I, Althaus CR, Althaus F, Genton B, , 2017. Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis. BMC Med 15: 147. [Google Scholar]
  19. Amland RC, Hahn-Cover KE, , 2016. Clinical decision support for early recognition of sepsis. Am J Med Qual 31: 103110. [Google Scholar]
  20. Larosa JA, Ahmad N, Feinberg M, Shah M, Dibrienza R, Studer S, , 2012. The use of an early alert system to improve compliance with sepsis bundles and to assess impact on mortality. Crit Care Res Pract 2012: 980369. [Google Scholar]
  21. Bradshaw C, Goodman I, Rosenberg R, Bandera C, Fierman A, Rudy B, , 2016. Implementation of an inpatient pediatric sepsis identification pathway. Pediatrics 137: e20144082. [Google Scholar]
  22. Hawkes M, Conroy AL, Opoka RO, Namasopo S, Liles WC, John CC, Kain KC, , 2014. Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda. Am J Trop Med Hyg 90: 605608. [Google Scholar]
  23. Mtove G, Nadjm B, Hendriksen IC, Amos B, Muro F, Todd J, Reyburn H, , 2011. Point-of-care measurement of blood lactate in children admitted with febrile illness to an African District Hospital. Clin Infect Dis 53: 548554. [Google Scholar]
  24. Boyce R, Reyes R, Matte M, Ntaro M, Mulogo E, Siedner MJ, , 2017. Use of a dual-antigen rapid diagnostic test to screen children for severe Plasmodium falciparum malaria in a high-transmission, resource-limited setting. Clin Infect Dis 65: 15091515. [Google Scholar]
  25. Feikin DR, Nguyen LM, Adazu K, Ombok M, Audi A, Slutsker L, Lindblade KA, , 2009. The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Trop Med Int Health 14: 5461. [Google Scholar]
  26. Schoeps A, Gabrysch S, Niamba L, Sié A, Becher H, , 2011. The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso. Am J Epidemiol 173: 492498. [Google Scholar]
  27. Siedner MJ, Lankowski A, Tsai AC, Muzoora C, Martin JN, Hunt PW, Haberer JE, Bangsberg DR, , 2013. GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. AIDS 27: 15031508. [Google Scholar]
  28. Wiens MO, 2015. A cohort study of morbidity, mortality and health seeking behavior following rural health center visits by children under 12 in southwestern Uganda. PLoS One 10: e0118055. [Google Scholar]
  29. Lankowski AJ, Siedner MJ, Bangsberg DR, Tsai AC, , 2014. Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review. AIDS Behav 18: 11991223. [Google Scholar]
  30. Manongi R, Mtei F, Mtove G, Nadjm B, Muro F, Alegana V, Noor AM, Todd J, Reyburn H, , 2014. Inpatient child mortality by travel time to hospital in a rural area of Tanzania. Trop Med Int Health 19: 555562. [Google Scholar]
  31. Berkley JA, Brent A, Mwangi I, English M, Maitland K, Marsh K, Peshu N, Newton CR, , 2004. Mortality among Kenyan children admitted to a rural district hospital on weekends as compared with weekdays. PediaCtrics 114: 17371738; author reply 1738. [Google Scholar]
  32. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis; , 2005. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6: 28. [Google Scholar]
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Supplemental appendices

  • Received : 18 Apr 2018
  • Accepted : 07 Jun 2018
  • Published online : 30 Jul 2018

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