Factors Associated with Mortality in Febrile Patients in a Government Referral Hospital in the Kenema District of Sierra Leone

Prerana J. Roth Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington

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Donald S. Grant Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington

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Amara S. Ngegbai Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington

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John Schieffelin Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington

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R. Scott McClelland Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington

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Olamide D. Jarrett Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington

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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, P = 0.001) and lack of diagnosis at discharge (AOR = 2.04, P = 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.

Author Notes

* Address correspondence to Olamide D. Jarrett, 808 South Wood Street, Room 888, Mail Code 735, Chicago, IL 60612. E-mail: ojarrett@uic.edu

Authors' addresses: Prerana J. Roth and Olamide D. Jarrett, Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, IL, E-mails: preranaroth@gmail.com and ojarrett@uic.edu. Donald S. Grant, Kenema Government Hospital, Kenema, Sierra Leone, and College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone, E-mail: donkumfel@yahoo.co.uk. Amara S. Ngegbai, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone, E-mail: drnas88@gmail.com. John Schieffelin, Department of Medicine, Tulane University, New Orleans, LA, E-mail: jschieff@tulane.edu. R. Scott McClelland, Department of Medicine, University of Washington, Seattle, WA, E-mail: mcclell@uw.edu.

  • 1.

    Crump JA, Gove S, Parry CM, 2011. Management of adolescents and adults with febrile illness in resource limited areas. BMJ 343: d4847.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Gakuruh T, 2009. Sierra Leone. Available at: http://www.who.int/countries/sle/en/. Accessed November 14, 2013.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    UNAIDS, 2012. Sierra Leone. Available at: http://www.unaids.org/en/regionscountries/countries/sierraleone/. Accessed November 14, 2013.

  • 7.

    Leone SS, 2004. Population Census. Available at: http://www.statistics.sl/publications.htm. Accessed December 7, 2013.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    World Health Organization, 2014. World Health Statistics 2014. Geneva: World Health Organization, 7289.

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