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Rautman LH, Maiga-Ascofaré O, Eibach D, Hogan B, Dekker D, Jaeger A, Akenten CW, Owusu-Dabo E, Boateng FO, Hanson H, Boahen KG, Sarpong N, Adu-Sarkodie Y, Kreuels B, May J, Krumkamp R. Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study. Trop Med Int Health 2024; 29:206-213. [PMID: 38093593 DOI: 10.1111/tmi.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Healthcare resources are often limited in areas of sub-Saharan Africa. This makes accurate and timely diagnoses challenging and delays treatment of childhood febrile illness. We explored longitudinal characteristics related to symptoms, diagnosis and treatment of hospitalised febrile children in a rural area of Ghana highly endemic for malaria. METHODS Febrile children under 15 years, admitted to the study hospital paediatric ward, were recruited to the study and clinical data were collected throughout hospitalisation. Descriptive statistics were reported for all cases; for longitudinal analyses, a subset of visits with limited missing data was used. RESULTS There were 801 hospitalised children included in longitudinal analyses. Malaria (n = 581, 73%) and sepsis (n = 373, 47%) were the most prevalent suspected diagnoses on admission. One-third of malaria suspected diagnoses (n = 192, 33%) were changed on the discharge diagnosis, compared to 84% (n = 315) of sepsis suspected diagnoses. Among malaria-only discharge diagnoses, 98% (n/N = 202/207) received an antimalarial and 33% (n/N = 69/207) an antibiotic; among discharge diagnoses without malaria, 28% (n/N = 108/389) received an antimalarial and 83% (n/N = 324/389) an antibiotic. CONCLUSIONS Suspected diagnoses were largely based on clinical presentation and were frequently changed; changed diagnoses were associated with lingering symptoms, underscoring the need for faster and more accurate diagnostics. Medications were over-prescribed regardless of diagnosis stability, possibly because of a lack of confidence in suspected diagnoses. Thus, better diagnostic tools are needed for childhood febrile illnesses to enhance the accuracy of and confidence in diagnoses, and to cut down unjustified medication use, reducing the risk of antimicrobial and malaria resistance.
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Affiliation(s)
- Lydia Helen Rautman
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Oumou Maiga-Ascofaré
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Hogan
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Denise Dekker
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | | | - Ellis Owusu-Dabo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Felix Osei Boateng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Henry Hanson
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Kennedy Gyau Boahen
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benno Kreuels
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
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Barathan M. From fever to action: diagnosis, treatment, and prevention of acute undifferentiated febrile illnesses. Pathog Dis 2024; 82:ftae006. [PMID: 38614961 PMCID: PMC11067964 DOI: 10.1093/femspd/ftae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 04/15/2024] Open
Abstract
Acute Undifferentiated Febrile Illness (AUFI) presents a clinical challenge, often characterized by sudden fever, non-specific symptoms, and potential life-threatening implications. This review highlights the global prevalence, types, challenges, and implications of AUFI, especially in tropical and subtropical regions where infectious diseases thrive. It delves into the difficulties in diagnosis, prevalence rates, regional variations, and potential causes, ranging from bacterial and viral infections to zoonotic diseases. Furthermore, it explores treatment strategies, preventive measures, and the critical role of the One Health approach in addressing AUFI. The paper also addresses the emerging zoonotic risks and ongoing outbreaks, including COVID-19, Rickettsia spp., and other novel pathogens, emphasizing their impact on AUFI diagnosis and management. Challenges in resource-limited settings are analyzed, highlighting the need for bolstered healthcare infrastructure, enhanced diagnostics, and collaborative One Health strategies. Amidst the complexity of emerging zoonotic threats, this review underscores the urgency for a multifaceted approach to mitigate the growing burden of AUFI, ensuring early diagnosis, appropriate treatment, and effective prevention strategies.
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Affiliation(s)
- Muttiah Barathan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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Alemu M, Asfaw Z, Lulekal E, Warkineh B, Debella A, Sisay B, Debebe E. Ethnobotanical study of traditional medicinal plants used by the local people in Habru District, North Wollo Zone, Ethiopia. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2024; 20:4. [PMID: 38178202 PMCID: PMC10768247 DOI: 10.1186/s13002-023-00644-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Ethiopia is a country located in the Horn of Africa, which combines richness in plant resources and cultures of human plant use. The people of Habru District of North Wollo Zone (Amhara Region, Ethiopia) have a long history of use of plant resources for various purposes including in traditional herbal remedy preparation and use. However, the district has not been adequately studied for its ethnobotanical resources and the associated knowledge. This study focused on human medicinal plants and their traditional uses in Habru District. The objective of the study was to document and analyze the plant species used by the local communities to treat human ailments along with the associated traditional knowledge and practices. METHODOLOGY The study was carried out in Habru District from June 2021 to December 2022. Ethnobotanical data were collected using semi-structured interviews, guided field walks, 13 focus group discussions (one at the district level and 12 at the kebele/subdistrict level) and market surveys. A total of 388 informants (250 males and 138 females) were selected from all 13 kebeles within Habru District using systematic random sampling, and 42 key informants were purposively selected. Descriptive statistics, preference ranking, direct matrix ranking, informant consensus factor and fidelity level were applied for data analysis. RESULTS The results provide insights into the medicinal plant diversity within Habru District, where 134 plant species in 110 genera and 54 families were documented, including 2 endemics, highlighting the district's significance in biodiversity conservation and healthcare delivery. Disease prevalence analysis showed that gastrointestinal and parasitic ailments (ICF = 0.85), febrile diseases (ICF = 0.84), and culture-related conditions exhibit high informant consensus factors. Remedy preparation involves various plant parts, predominantly leaves (47.3%), followed by roots (22.1%), fruits (7.0%), and seeds (5.8%). Freshly harvested plant parts were frequently used (58.2%), while 24.7% involved both dried and fresh parts. Oral application (47.3%) and topical use (31.8%) are the major routes of remedy administration. The marketability of medicinal plants was evident, with 16.4% of the species reported as marketable, including Terminalia brownii Fresen. Myrtus communis L., Ruta chalepensis L., Olea europaea L. subsp. cuspidata (Wall. & G.Don) Cif., Allium sativum L. and Capsicum annuum L. Multipurpose plants such as Solanum somalense Franchet. (91.3% FL), Ocimum lamiifolium Hochst. ex. Benth. (88.9% FL), and Verbascum sinaiticum Benth. (85.7% FL) exhibited notable healing potentials. CONCLUSION The current study underscores the intricate relationship between the local community and medicinal plants, emphasizing the importance of biodiversity conservation and health care and acknowledging the dynamic interplay between cultural heritage and ecosystem health. The results contribute to the development of sustainable conservation strategies, healthcare practices and the preservation of traditional knowledge, and highlight the interdependence of human societies and their natural environments. Community-based conservation initiatives with active participation of local communities are desirable for the conservation and sustainable use of medicinal plant species and their habitats. Raising public awareness about the sustainable harvesting and utilization of marketed medicinal plants (e.g., Terminalia brownii Fresen.) that are under threat is also important to ensure their availability for future generations and contribution to socioeconomic development.
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Affiliation(s)
- Mulugeta Alemu
- Department of Plant Biology and Biodiversity Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Urban Agriculture, Nefas Silk Polytechnic College, Addis Ababa, Ethiopia.
| | - Zemede Asfaw
- Department of Plant Biology and Biodiversity Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ermias Lulekal
- Department of Plant Biology and Biodiversity Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bikila Warkineh
- Department of Plant Biology and Biodiversity Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asfaw Debella
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Bihonegn Sisay
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Eyob Debebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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