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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DOI:
https://doi.org/10.4269/ajtmh.14-0418
Volume/Issue:
Volume 92: Issue 1
Page(s):
172–177
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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.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2015
Received:
04 Jul 2014
|
Accepted:
16 Sep 2014
|
Published Online:
07 Jan 2015
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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